Encrusted uretero-pyelitis is a rare and serious disease, related to the presence of calcifications in the pelvicalyceal system and ureter, associated with chronic urinary tract infection. In most cases, the causal agent of this infection lithiasis is corynebacterium urealyticum. The specific aspect of calcifications on CT scan can help to suggest diagnosis. To avoid a delay in diagnosis (which is frequent), an accurate exploration by the bacteriologist is crucial. The combination of a glycopeptides antibiotherapy and urine acidification has proved its effectiveness, as described in the medical literature. We report the case of a 77-year-old male patient, successfully treated for a bilateral encrusted uretero-pyelitis by local acidification (Thomas's solution) followed by oral acidification (ammonium chloride).
Forniceal rupture secondary to acute ureteral obstruction is relatively common. However, spontaneous ureteral rupture is less frequently encountered. Most reported cases were stone related, localized at the ureteropelvic junction and managed in a minimally invasive manner. We present a case of stone induced ureteral rupture below the UPJ, with bacterial and fungal superinfections, that failed conservative management and lead eventually to nephrectomy. No such scenario has ever been reported in the literature. As rupture of the ureter can cause serious complications, including urinoma, sepsis and sometimes kidney loss, prompt recognition, treatment and follow-up of the condition is therefore necessary.
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