Obstructive uropathy-acute and chronic medical management

Obstructive uropathy is an important cause of acute and chronic kidney disease.Decompression of the urinary tract is an essential aspect of treatment.The cause and aetiology of obstruction typically determine the surgical approach.Acute relief of obstruction is frequently complicated by fluid and electrolyte imbalance.Standard therapeutic interventions for acute or chronic renal failure also apply for cases of obstructive uropathy.This narrative review summarises the early and long-term medical management of obstructive uropathy.

Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury

Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract.It is regarded as one of the most prevalent causes of acute kidney injury(AKI),accounting for 5%–10%of cases.Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction.The aim of the present article is to review and synthesize available evidence on obstructive uropathy,providing a clinical guideline for clinicians.A literature review on obstructive uropathy in the context of AKI was performed,focusing on the least clarified aspects regarding diagnosis and management.Recent literature searching was conducted in English and top-level evidence articles including systematic reviews,metanalyses and large series were prioritized.Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney.Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection.A multidisciplinary approach,including urologists,nephrologists,and other medical specialties,is best suited to correctly manage concomitant hemodynamic changes,fluid and electrolyte imbalances,and other related issues.Obstructive uropathy is one of the leading causes of AKI.Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challeng-ing.A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.

Stevens-Johnson Syndrome complicated by obstructive uropathy,pneumothorax,and pneumomediastinum:a case report and literature review

Background:Stevens-Johnson Syndrome(SJS)is an acute mucocutaneous eruption with blisters of the skin and haemorrhagic erosions of mucous membranes.This report describes air-leak syndrome and obstructive uropathy occurring simultaneously in a teenage patient affected by SJS.Case presentation:A 17-year-old Malay female with SJS suffered from bilateral pneumothoraces,pneumomediastinum,and obstructive uropathy as early complications of her disease.She required intubation,chest tube insertion,and bilateral ureteric stenting as part of her intensive care management.These extracutaneous complications of renal and pulmonary systems were likely secondary to widespread epithelial detachment.Conclusion:Despite paucity of cases in adult literature,post-renal causes for acute kidney injury must be considered in SJS,especially in the setting of gross haematuria.Bedside point-of-care ultrasonography may be a useful tool for excluding obstructive uropathy.Pneumothorax is a rare but documented complication of SJS in paediatric cases and,to a lesser extent,adult patients.Extra care should be exercised when caring for mechanically ventilated patients suffering from SJS.

The Outcome of Transvesical Prostatectomy—A Multicenter Retrospective Study

Background: Benign Prostatic Hyperplasia (BPH) is one of the commonest causes of lower obstructive uropathy and usually presents with lower urinary tract symptoms. However, in developing nations, the presentation is late often large prostate and associated complications of bladder outlet obstruction (diverticulae, stones, impaired renal function etc.) warranting open prostatectomy. Objective: The objective of this study is to share our experience of perioperative outcomes of open transvesical prostatectomy over a year involving two referral centers in Monrovia Liberia. Methodology: This was a retrospective study performed at The John F. Kennedy Medical Center and the Saint Joseph Catholic Hospital involving a total of 31 patients. Results: The mean age was 64.6 years (SD = 9.03) with a range 52 - 85 years. The study showed that 54.8% (17/31) of patients had preoperative catheter. The maximum duration of Catheter was greater than 4 weeks with a mean duration of 3.17 weeks. The mean hemoglobin was 11.30 g/dl. The commonest presenting complication was urinary retention at 25.8% (8/31) followed by hematuria 16.1% (5/31). Hypertension 41.9% (13/31) and diabetes 6.5% (/31) were the commonest comorbidity. The rate of postoperative complication was 38.7% with the commonest being surgical site infection 16.1% (5/31) and clot retentions 9.7% (3/31). There was a high rate of transfusion was 77.4% (24/31) patients. Up to about 13% (4/32) patients had coexisting stricture with 6.5% (2/31) patients treated with urethroplasty and 6.5% (2/31) patients treated by dilatation. The mortality rate was 6.5% (2/31) from renal impairment and severe sepsis. Conclusion: BPH is a common cause of lower obstructive uropathy. Most patients present with complications of the disease such as refractory symptoms, bladder stones or diverticulae necessitating surgery. However, due to the absence of endourological equipments in most parts of Africa and the large prostate at presentation, most settings consider open transvesical prostatectomy as a viable option. The perioperative morbidity is relatively higher, but the outcome remains acceptable.

Bilateral stones as a cause of acute renal failure in the emergency department

BACKGROUND: Acute renal failure(ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive.METHODS: We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy(SWL) for dissolution of calculi.RESULTS: The patient was successfully treated, and reported asymptomatic in a follow-up.CONCLUSION: Close collaboration between nephrological, urological, and radiological services is required.

Urologic Pathologies of Child at Ouagadougou

Introduction: Urologic pathologies of children are frequent. Urinary apparatus diseases occupy the third position after those of respiratory and digestive tracts in children. Objectives: The objective of this study was to investigate epidemiologic, diagnostic, and therapeutic aspects of urologic pathologies of children in our hospital. Patients and Methods: This work is a descriptive and retrospective study from January 1st 2005 to December, 31st 2012 on children from 0 to 15 years old admitted and treated in Teaching Pediatric Hospital Charles de Gaulle for a urologic pathology. Results: In total, 711 patients had been registered with 7.3 sex-ratio, an average age of 4 years old (0 - 15 years old). Malformative pathologies were represented by the majority (62.7%). They were mainly composed of peritoneovaginal canal pathology, posterior urethra valves (PUV), and Pyeloureteral junction anomaly (PUJA). Urolithiasis, infectious, and tumoural pathologies were second, third and fourth with 19.4%, 7.6% and 5.8% respectively. Surgical treatment was necessary for 83.2% of patients. A total nephrectomy has been realized in 5 cases for PUJA with mute kidney. Some post-operative complications have been observed in 2.6% of operated patients. The global mortality rate was 2.9% with Wilms’ tumor predominance in aetiology (58.8%). Conclusion: Urologic pathologies of children are dominated by urogenital malformations. The decreasing of their lethality is guided by a MU antenatal diagnosis and a personal qualification to improve the diagnosis and the treatment.

Impact of liver disease severity on outcomes of patients undergoing endourological procedures for urolithiasis

Objectives:This study is aimed to determine the impact of liver disease severity on the outcome of patients undergoing endourological procedures for urolithiasis,and to understand the factors that are helpful in improving the outcome.Materials and methods:We retrospectively analyzed the records of patients with chronic liver disease who underwent endourological procedures between January 2014 and February 2020.Inpatient records and charts were assessed for age,sex,height,weight,body mass index,model for end-stage liver disease(MELD)score,Child-Turcotte-Pugh score,type of procedure and anesthesia,intensive care unit(ICU)stay,duration of hospitalization,number,size,and position of stones,and postoperative complications such as hematuria,sepsis,and secondary procedures.Data are presented as mean±standard deviation or frequency.The chi-square test was applied to determine the exact association between categorical data and Student t-test or Mann-Whitney U test as appropriate for continuous data.Statistical significance was set at p<0.05.Results:Hospital and ICU stay as well as administration of different blood products were significantly longer in the Child C than in the Child A and B categories(p<0.001).Two patients in the Child C category died,while 3 left the hospital against medical advice.The duration of ICU stay and blood products administered increased with augmenting MELD scores.The durations of hospitalization and blood product administration were significantly higher in patients with an MELD score≥20 than in the group with MELD score<20.Conclusions:Hospital and ICU stay and blood product administration were significantly higher in Child C than in Child A and B class patients.Hospitalization duration and blood product administration were significantly higher in patients with an MELD score≥20.