Context:
Emphysematous pyelonephritis (EPN) is a dangerous necrotizing infection of the kidney involving the diabetics with a high case fatality rate. Recent medical literature has shown shifting of treatment strategy from conventional radical approach to minimally invasive approach.
Aims:
The aim of our study was to assess the role of minimally invasive stepwise decompression techniques in the management of EPN and preservation of the renal unit.
Settings and Design
: This was a retrospective observational study conducted from June 2017 to April 2020 at a tertiary care centre.
Material and Methods:
We reviewed the hospital online records of 18 patients diagnosed with EPN for patient demographics, clinical profiles, co-morbidities, laboratory and, radiological investigations, surgical interventions performed and the outcomes. The severity of EPN was graded as per the Huang classification. Patients underwent surgical interventions as per the treatment protocol and response was assessed.
Statistical Analysis Used:
Descriptive statistics was applied.
Results:
Diabetes mellitus was present in 15 (83.3%) patients along with urinary tract obstruction in 8 (44.4%) patients. Flank pain (77.7%) was the most common presenting clinical feature while
Escherichia coli
(55.5%) were the most common causative organism. Most patients (50%) had Type- II EPN, all of which were managed successfully by minimally invasive procedures. In total seventeen patients (94.4%) responded well while one patient (5.5%) underwent nephrectomy with no mortality.
Conclusions:
Renal salvage in EPN requires multidisciplinary approach including the initial medical management followed by properly selected stepwise decompressive surgical techniques. Conservative management and decompression techniques have shown to improve patient's outcome, reducing the traditional morbidity associated with nephrectomy.
Background: During pandemic of coronavirus disease 2019 (COVID-19), there is a need for prioritization of the patients. Suspension of elective procedures avoids the load on already burdened medical facilities. Our aim was to highlight the pattern of urological procedures during the pandemic, preventive protocol used, and challenges faced in their management.Methods: This was a retrospective observational study of 152 patients who underwent urological procedures between March 22 and June 30, 2020, at a tertiary care centre. Outpatient department (OPD) consultation and elective urological procedures were suspended. Only emergency, semi-emergency, and OPD room procedures were performed. Procedures were classified into four categories i.e. emergency, semi-emergency, OPD room, and elective procedures. Patient demographics and operative details were assessed. Descriptive statistics were applied.Results: A total of 152 patients were included in the study. Majority of the patients were our follow up (70.4%) and rest were new patients (29.6%). Out of the total procedures done, 67.1% were emergency or semi-emergency and 32.9% were OPD room procedures. Local anaesthesia was the most used anaesthesia (69.1%). COVID-19 swab testing was done only for the inpatients (41) of which eight patients were tested positive. In the end, none of the health care workers had symptoms of COVID-19.Conclusions: The pattern of surgeries shows that most of the urological procedures performed during COVID-19 pandemic were for either emergency or semi-emergency urological conditions. Obstructive uropathy is one of the commonest indications for the urological procedures performed during this pandemic.
Background
Spongioplasty alone or in combination with local tissue flaps can be used as a second layer for the prevention of complications of tubularised incised plate urethroplasty (TIPU) of hypospadias repair. It can be used when wide urethral plate and well-developed robust spongiosum are present. This study aims to review the success rate and complications of TIPU performed utilising spongioplasty alone as a second layer in Type 3 well-developed robust spongiosum.
Methods
This is a retrospective observational study conducted between January 2015 and December 2019 at a tertiary care centre. A total of 21 patients aged 4–15.4 years with primary hypospadias having a Type 3 well-developed robust spongiosum, Glans score ≤ 2, Meatal score ≤ 4, and Shaft score ≤ 3 underwent TIPU using spongioplasty alone as a second layer. The hospital stay ranged from 10 to 14 days and follow-up from 12 to 36 months.
Results
Hypospadias was distal in 12 (57.1%), mid in 5 (23.8%), and proximal penile in 4 (19.1%) patients. The mean Glans Meatus Shaft score was 6.1 (G = 1.25, M = 2.95, S = 1.9) with a range of 3–9. An early post-operative complication of preputial oedema and bladder spasm developed in 1 (4.7%) patient each. Meatal stenosis developed in 1 (4.7%) patient. None developed urethrocutaneous fistula. At 3 months all patients had good urinary flow (> 15 ml/s) and good cosmesis. All the patients/parents (in case of minors) were satisfied with the result.
Conclusion
Spongioplasty alone as the second layer after TIPU for primary penile hypospadias in patients with well-developed robust spongiosal tissue is associated with minimal, easily manageable complications.
Supra-pubic catheterization of bladder is used as a short or long term alternative to per-urethtral catheterization.
Some catheter materials are more resistant to encrustation than others. If kept indwelling for longer duration, sooner or later all catheters cause complications like urinary tract infection (UTI), trauma, peri-catheter leakage, non-deflation of balloon, encrustations and stone formations resulting into retained catheter.
Stone formation over neglected indwelling catheter is not an unusual clinical scenario and its management depends on etiology of catheter retention and complication.
This article discusses etiopathogenesis, clinical presentations, diagnosis and varied management options used for the neglected retained supra-pubic catheter in three cases
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