Background: Urolithiasis during pregnancy is a complex health problem that can affect maternal and fetal health, needs adequate understanding of the management options available and their relative pros and cons. Patient management needs involvement of obstetrician, radiologist and urologist, as a multidisciplinary team, to avoid any obstetric complications, such as spontaneous abortion and preterm delivery. Aims and Objectives: The aim of the study was to evaluate urolithiasis and its management in pregnant women at our tertiary care center. Materials and Methods: We analyzed data of 45 patients diagnosed with urolithiasis during pregnancy between January 2017 and March 2022.We evaluated patients age, gestational age history of urolithiasis, physical examination findings, routine laboratory findings, location, and size of the stone. The effectiveness and complications of the applied treatment methods were also evaluated. Results: The mean age of 45 patients included in our study was 25 (25.2±4.8) years with mean gestational age of 18.2 weeks. The mean stone size was 10.2 mm and the most common symptom at the time of presentation to hospital was flank pain (73%). Kidney stones were detected in 26 patients and ureteral stones in 19 patients. Although conservative treatment was sufficient in 22 (48.9%) patients, 31 (51.1%) patients required surgical intervention. Major obstetric complications, such as preterm delivery and miscarriage, did not occur in any patients. Conclusion: Urolithiasis during pregnancy can pose a challenge to urologists, obstetricians, and radiologists, requiring a prompt diagnosis and urgent treatment. On failure of medical management, definitive endoscopic treatment of an acute stone event is a reasonable strategy. In determining the treatment options, fetal and maternal health should be of utmost importance.
Background: Xanthogranulomatous pyelonephritis (XGP) is chronic pyelonephritis subtype where in renal parenchymal destruction occurs and therefore results in progressive loss of kidney functions. Although middle age group is the predominant age group affected but it can be seen at any age. There is accumulation of macrophages (lipid-laden) leading to renal parenchymal destruction and fibrosis. In this study, we present our data of 15 patients who had undergone nephrectomy and were biopsy proven XGP. Aims and Objectives: The aim of the study was to describe the clinical and radiological features of XGP in adults. Materials and Methods: XGP constituted 4.31% of the 348 nephrectomies done for infective causes over a period of 7 years. All our patients had undergone unilateral total nephrectomy. Demographic and clinical records were analyzed after consent from all the patients. Results: The age range in our study was 18–65 years with mean 42.93±15.66 years. Nine of our patients, that is, 60% were females. Diabetes was present in 53.3% of our patients. Three patients had imaging suggestive of pyonephrosis, three patients had perinephric collection and 9 patients (60%) had concomitant nephrolithiasis. All the kidneys were grossly enlarged and were non-functional on renal scintigraphy. Conclusion: XGP is a form of chronic pyelonephritis which although being less common but is devastating given the destruction of renal parenchyma it does and associated morbidity. Clinicoradiologic correlation cannot be overemphasized. The definitive diagnosis is established after histopathologic examination.
Placenta percreta is an obstetric emergency often associated with massive hemorrhage, emergency cesarean section, and peripartum hysterectomy. We present a case of a 30-year-old woman, G4P1L1A2 with placenta percreta managed by an alternative approach. The placenta was left in situ along with B/L internal iliac artery ligation during cesarean section and later on delayed subtotal hysterectomy with bladder repair was successfully performed. Placenta percreta spectrum is an obstetricians dilemma associated with massive hemorrhage and is a potential life-threatening condition for both mother and the baby. Cesarean section with B/L internal iliac artery ligation and delayed hysterectomy may be a reasonable strategy in the most severe cases.
Aim: to highlight the transvaginal route as an effective approach for repair of simple vesico-vaginal and urethro-vaginal stulae without compromising patient outcomes. Materials and Methods: A retrospective analysis was carried out on 45 patients with simple trigonal, supra trigonal and urethrovaginal stula who underwent transvaginal repair in the last 3 years. Simple stulas were dened as stula less than 3 cm in size or recurrent stulae less than 1.5–2 cm in size and located either supra-trigonally (above the bar of mercier) or sub-trigonally (below the bar of mercier) as determined by cystoscopy. Results: Obstetric cause, due to obstructed labour, was the most common cause of stula formation (68.96%), while remaining (29.31%) were attributed to hysterectomy. Primary stulae were found in 68.9% of patients and recurrent stulae in 31.1% patients. The mean age of patients was 34.30 years. Average stula size was 1.5 cm. The success rate of primary operation was 84.12%. On using a multivariate regression model, the underlying aetiology (OR 2.2), stula location (OR 2.5) and history of previous repair (OR 2.4) were found to be signicant factors affecting outcome. Conclusion: The transvaginal approach is less invasive and achieved comparable success rates as compared to other methods of vesico-vaginal stula repair. We postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible vesico vaginal stulae, both of obstetrical and gynaecological origin.
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