Dear editor,A 55-year-old man presented with dyspnea and involuntary dribbling of urine for 1 month.He had history of straining during micturition and weak urinary stream for a year.On examination,he was disoriented a...Dear editor,A 55-year-old man presented with dyspnea and involuntary dribbling of urine for 1 month.He had history of straining during micturition and weak urinary stream for a year.On examination,he was disoriented and had abdominal distension.Ultrasound revealed marked ascites,pleural effusion,bilateral hydroureteronephrosis,and distended bladder with prostatic urethral calculus.A non-contrast computerized tomography scan additionally showed thickened bladder wall with florid mucosal calcification suggestive of encrusted cystitis and a 2.9 cm×2.5 cm calculus in the prostatic urethra extending to the bulbar urethra(Fig.1).His hemoglobin was 6 g/dL;urea and creatinine were elevated(114 mg/dL and 8.4 mg/dL,respectively);and the leucocyte count was 16.3×109/L.After initial resuscitation,ultrasound guided supra-pubic catheterization was performed.The urine pH was 8.4 while the microscopy revealed numerous pus cells,bacteria,and inorganic crystals.A nephrology consultation was taken and considering the clinical picture of encrusted cystitis,he started on intravenous vancomycin.He also received a session of hemodialysis.The patient died of cardiovascular collapse on the second post admission day.The urine culture report,obtained posthumously,revealed Corynebacterium urealyticum corroborating the diagnosis of encrusted cystitis.The strain was multidrug resistant and showed only sensitivity to teicoplanin and vancomycin.展开更多
Background:Transurethral resection of bladder tumor(TURBT)is associated with perioperative morbidity of 5%to 10%,which can lead to unplanned readmissions.In this study,we aimed to identify the factors that lead to an ...Background:Transurethral resection of bladder tumor(TURBT)is associated with perioperative morbidity of 5%to 10%,which can lead to unplanned readmissions.In this study,we aimed to identify the factors that lead to an increased risk of unplanned readmissions within 30 days of primary TURBT.Materials and methods:A retrospective study was conducted to identify patients who underwent primary TURBT at our institute from 2011 to 2019.Clinical and demographic factors,history of smoking,antiplatelet drugs intake,comorbidities,tumor size(<3 or>3 cm),multifocality,and histopathological type were abstracted.Patients who were readmitted were identified,and reasons for admission were recorded.Results:A total of 435 patients were identified.The median age of the patients was 66 years.From 378 male patients(86.9%),110(25.3%)and 37(8.5%)had a history of smoking and antiplatelet agents intake,respectively.In the cohort,166 patients(38.2%)were diabetic,239(54.9%)were hypertensive,72(16.6%)had chronic obstructive pulmonary disease,and 78(7.9%)had hypothyroidism.A total of 206 patients(47.4%)had a tumor>3 cm;multifocality was seen in 140(32.2%)patients,whereas muscle invasive tumors were present in 161 patients(37%).A total of 22 patients(5.06%)had readmissions within 30 days,with hematuria being the most common etiology.On univariate and multivariate analyses,a history of smoking(p=0.006 and p=0.008,respectively)or antiplatelet agents intake(p<0.001 and p<0.001,respectively)was significantly associated with increased unplanned readmission.Conclusions:Our study revealed smoking and antiplatelet agents intake as factors leading to an increased risk of unplanned readmissions.展开更多
文摘Dear editor,A 55-year-old man presented with dyspnea and involuntary dribbling of urine for 1 month.He had history of straining during micturition and weak urinary stream for a year.On examination,he was disoriented and had abdominal distension.Ultrasound revealed marked ascites,pleural effusion,bilateral hydroureteronephrosis,and distended bladder with prostatic urethral calculus.A non-contrast computerized tomography scan additionally showed thickened bladder wall with florid mucosal calcification suggestive of encrusted cystitis and a 2.9 cm×2.5 cm calculus in the prostatic urethra extending to the bulbar urethra(Fig.1).His hemoglobin was 6 g/dL;urea and creatinine were elevated(114 mg/dL and 8.4 mg/dL,respectively);and the leucocyte count was 16.3×109/L.After initial resuscitation,ultrasound guided supra-pubic catheterization was performed.The urine pH was 8.4 while the microscopy revealed numerous pus cells,bacteria,and inorganic crystals.A nephrology consultation was taken and considering the clinical picture of encrusted cystitis,he started on intravenous vancomycin.He also received a session of hemodialysis.The patient died of cardiovascular collapse on the second post admission day.The urine culture report,obtained posthumously,revealed Corynebacterium urealyticum corroborating the diagnosis of encrusted cystitis.The strain was multidrug resistant and showed only sensitivity to teicoplanin and vancomycin.
文摘Background:Transurethral resection of bladder tumor(TURBT)is associated with perioperative morbidity of 5%to 10%,which can lead to unplanned readmissions.In this study,we aimed to identify the factors that lead to an increased risk of unplanned readmissions within 30 days of primary TURBT.Materials and methods:A retrospective study was conducted to identify patients who underwent primary TURBT at our institute from 2011 to 2019.Clinical and demographic factors,history of smoking,antiplatelet drugs intake,comorbidities,tumor size(<3 or>3 cm),multifocality,and histopathological type were abstracted.Patients who were readmitted were identified,and reasons for admission were recorded.Results:A total of 435 patients were identified.The median age of the patients was 66 years.From 378 male patients(86.9%),110(25.3%)and 37(8.5%)had a history of smoking and antiplatelet agents intake,respectively.In the cohort,166 patients(38.2%)were diabetic,239(54.9%)were hypertensive,72(16.6%)had chronic obstructive pulmonary disease,and 78(7.9%)had hypothyroidism.A total of 206 patients(47.4%)had a tumor>3 cm;multifocality was seen in 140(32.2%)patients,whereas muscle invasive tumors were present in 161 patients(37%).A total of 22 patients(5.06%)had readmissions within 30 days,with hematuria being the most common etiology.On univariate and multivariate analyses,a history of smoking(p=0.006 and p=0.008,respectively)or antiplatelet agents intake(p<0.001 and p<0.001,respectively)was significantly associated with increased unplanned readmission.Conclusions:Our study revealed smoking and antiplatelet agents intake as factors leading to an increased risk of unplanned readmissions.
