Pyelonephritis and Pyonephrosis

Urinary tract infection (UTI) occurs in approximately 8 of girls and 6 of boys during their first 6 years of life (Marild and Jodal 1998). Although older patients Fig. 8.16a-c. DMSA scan showing multiple photopenic areas consistent with renal scars (Courtesy H.G. Rushton) may complain of irritative voiding symptoms and thus direct clinical suspicion to the urinary tract, infants and neonates may present with only nonspecific symptoms such as poor feeding, irritability, and failure to thrive....

Physical Examination

The general appearance of the patient is one of the most important factors to consider when examining the patient. The diagnostic possibilities for a patient with ca-chexia are different than a well-nourished patient complaining of flank pain. Patients with classic colic will appear uncomfortable however, the diagnosis is not always stone disease. A similar appearance can be seen in patients with other urologic problems such as UPJ obstruction or less commonly ureteral tumors. Completely...

Unilateral Upper Urinary Tract Obstruction

One of the most common forms of failed drainage in the upper urinary tract is acute unilateral ureteral ob- Table 10.1. Etiology of upper urinary tract obstruction Intrinsic Urothelial carcinoma Fibroepithelial polyp UPJ obstruction Renal cell carcinoma Wilms tumor Cystic renal diseases Parapelvic cysts Renal artery aneurysm Retroperitoneal malignancy (primary or metastatic) Inflammatory bowel disease Trauma (ureteral ligation) Radiation therapy Lymphocele Urinoma Retroperitoneal fibrosis...

Diagnostic Tests and Risk Factors

There are many different diagnostic tests, including serum tryptase, plasma histamine, specific IgE-level measurements, and skin tests. However, all of these tests have their pitfalls. An elevated tryptase level 1 - 6 h after a suspected anaphylactic reaction indicates mast cell degranulation. Together with a suggestive history and clinical findings, this supports the diagnosis of anaphylaxis (Fisher and Baldo 1998). However, serum tryptase concentration may be normal even in fatal anaphylaxis....

Immediate and Nonimmediate Reactions to Contrast Media

Since their development in the 1950s tri-iodinated benzene derivates have been used for opacification of the urinary tract. The radiopacity of such compounds is produced by molecular iodine, which is attached to the benzene ring. The agents are further characterized by their ionic and nonionic side chains as well as their monomeric or dimeric ring structure. Contrast media are used in many diagnostic and in-terventional procedures, including intravenous ur-ography, CT scan, angiography,...

Urinary Tract Infection

Urinary tract infections are relatively rare in male patients, but they do represent a proportion of men attending with AUR. Many of these patients will have a degree of BOO and or LUTS, and some will be known to have incomplete bladder emptying. They are also commonly seen in BOO caused by stricture disease. The patient will typically give a history of LUTS, but associated with a short-term history of dysuria, offensive-smelling or dark cloudy urine, and suprapubic pain. Some patients may...

Urinary Tract Infections

Because of anatomic, functional, and hormonal modifications, urinary tract infection is frequent during pregnancy. It can present as three different entities asymptomatic bacteriuria, acute cystitis, or acute pyelonephritis (Ovalle and Levancini 2001). Different risk factors have been discussed maternal age, socioeconomic status, antecedents of UTI, sexual intercourse, hemoglobinopathies, diabetes, immunodepression of HIV infection, multiparity, and race (Connolly and Thorpe 1999 Ovalle and...

Complications

Early complications occur within the 1st month after injury and can be bleeding, arteriovenous fistulae involving the renal artery, infection, perinephric abscess, sepsis, urinary fistula, hypertension, urinary extravasation, and urinoma. Delayed complications include bleeding, hydronephrosis, calculus formation, chronic pyelonephritis, hypertension, arteriovenous fistula, hydronephrosis, and pseudoaneurysms. Delayed retroperitoneal bleeding usually occurs within several weeks of an injury or...

Urological Aspects of Terrorist Related Injuries

A review of the literature reveals that there is a paucity of data on terrorist-related urological injuries. Important data is available from the Israeli Trauma Registry (ITR), which records all hospitalizations for physical trauma at most of the Israeli trauma centers. Unfortunately, the accumulated experience of the Israeli medical system with terrorist-related injuries during the last two decades is exceptional in duration and intensity, out-ranging any comparable practice gained elsewhere,...

Hemorrhagic Cystitis

Hemorrhagic cystitis is defined as gross hematuria secondary to diffuse inflammation of the bladder. Viral infection, radiation-induced inflammation, and chemotherapy-induced inflammation account for the majority of cases among cancer patients. While relatively un- common in patients with genitourinary malignancies, viral-mediated hemorrhagic cystitis occurs in as many as 50 of patients undergoing bone marrow transplantation (Bedi et al. 1995). The principle etiologic factor involved is the BK...

1

The production of PTH-like compound is detected in vivo in patients with renal cell carcinoma, as well as in the supernatant of human renal cell carcinoma cells transplanted into nude mice (Weissglas et al. 1995 Strewler et al. 1986). Recent studies have examined a possible contribution of IL-6, known to stimulate osteoclastic bone resorption, to the hyper-calcemia of renal cell carcinoma (Weissglas et al. 1995). PTHrP was purified from renal cell carcinoma as a...

Gynecomastia

About 10 of choriocarcinoma of the testis and 15 - 20 of gonadal stroma sex cord testicular tumors induce gynecomastia through their autonomous synthesis and secretion of estrogens. Tumor estrogen production may also cause decreased libido and poor sperm quality. The diagnosis of these hormone producing tumors is usually clinically evident from the finding of a testicular swelling that might be painless or painful. Occasionally the sole presenting feature is gynecomastia or very rarely...

Radiation Cystitis

Radiation cystitis is a late complication of radiotherapy which, by definition, occurs at least 90 days after the initiation of radiation treatment but maybe delayed up to 10 years or more (Cox et al. 1995). Most patients develop severe irritative voiding symptoms however, gross hematuria dominates the clinical picture (Pas-quier et al. 2004). While any patient receiving pelvic radiotherapy is at risk, radiation cystitis is most common among those treated for prostate or cervical cancer. Three...

Solid Renal and Juxtarenal Lesions

Vincristine Syringe

The majority of solid renal or juxtarenal lesions present either prenatally or as a palpable abdominal mass in childhood. The most common renal tumor in the neonate remains congenital mesoblastic nephroma (CMN). More than 80 are diagnosed in the 1st month of life and essentially all are identified by 1 year of age (Geller et al. 1997). CMN usually presents as an asymptomatic abdominal mass however, prenatal US has also demonstrated polyhydramnios, fetal hydrops, and premature delivery in...

Intensive Care Procedures 351

Stroke Volume Variation

The use of analgetics and sedatives for the treatment of pain, anxiety, and agitation is a daily challenge in the intensive care environment. It is usually needed for the mechanically ventilated patient. To achieve a sufficient level of patient shielding while minimizing side effects and a short and cost-effective weaning period, the algorithm for analgosedation (AS) is an important task for the clinician. Emphasis should be placed on the consequent and correct implementation of a concept while...

References

Allen ZA, Merrick GS, Butler WM et al 2005 Detailed urethral dosimetry in the evaluation ofprostate brachytherapy-relat-ed urinary morbidity. Int J Radiat Oncol Biol Phys 62 981 Allgood RJ, Cook JH, Weedn RJ et al 1970 Prospective analysis of pulmonary embolism in the postoperative patient. Surgery 68 116 Andriole GL, Sandlund JT, Miser JS et al 1987 The efficacy of mesna 2-mercaptoethane sodium sulfonate as a uropro-tectant in patients with hemorrhagic cystitis receiving further...

Tumors

Appendix Testis

Any mass originating from the testicle must be presumed to be testicular cancer until otherwise proven, because of the explosive growth and metastatic potential of germ cell testicular cancers. While rare, testis cancers are the most common solid tumor of young adult males. Germ cell tumors make up approximately 95 of all testis tumors and are seminoma, yolk sac, choriocarcinoma, embryonal, and teratoma. Stromal testis tumors are rare and are found almost exclusively in prepubertal individuals....

Torsion of Testicular Appendages

The most common testicular appendage susceptible to torsion is the appendix testis, which is a remnant of the Mullerian duct. Presentation is usually the same as that for testicular torsion. Patients are most often adolescents and present with the sudden onset of orchalgia. Occasionally, early in the course of the process, before edema has developed, it is possible to palpate the twisted appendage as a small 3- to 5-mm tender area or mass close to the upper pole of the testis. Also, rarely, a...

Epididymitis

Epididymitis is an inflammatory reaction of the epididymis to one of several infectious agents or to local trauma. Acute epididymitis may present at any age, with a sudden onset of pain and swelling of the epididymis in the scrotum. Epididymitis can present in a sexually transmitted form or one associated with urinary tract infections and prostatitis. Thus, eliciting a specific history of sexual exposure or of prior genitourinary tract disease is crucial for diagnosis and appropriate treatment....

Pseudohermaphroditism

Newborn Female Normal Genital

Pediatric urologic emergencies fortunately remain rare occurrences within the emergency department of a hospital or ambulatory care center. More commonly, congenital anomalies noted at birth, or benign lesions that prompt significant parental anxiety such as benign scrotal conditions , often result in a visit to the emergency department for evaluation. These urgencies nonetheless require both the appropriate investigations and management in order to allay patient and parental concern. The...

Noncontrast Helical Abdominal Pelvic CT

Urogram Technique

In the emergency room setting, noncontrast helical abdominal pelvic CT has become the examination of choice in the evaluation of flank pain and obstructive anuria Niall et al. 2002 Shokeir et al. 2002, 2004 Coli-stro et al. 2002 . Introduced by Smith and colleagues in 1995, noncontrast CT is quick, relatively easy to interpret, and obviates risks associated with the use of contrast media Smith et al. 1999 . Noncontrast CT is the gold standard in the detection of urinary calculi with an...

Cardiac Failure Treatment Instant

Fluid Chart For Dialysis Patients

Continue p-blockers, Dosage 0 if applicable Statins Epiduralcatheter Start p-blocker-therapy or consult cardiologist Perioperative arrhythmias are caused by physiologic and pathologic disturbances or by pharmacologic drug effects. Physiologic disturbances include hypoxemia, hypercapnia, acidosis, hypotension, hypovolemia, electrolyte imbalances, adrenergic stimulation light anesthesia , vagal stimulation, and mechanical irritation chest tube, pulmonary artery catheter . Pathologic cardiac...

Comparison of Temporary Drainage Techniques

Despite limited options, the method for urgent decompression of the obstructed urinary tract is controversial. Proponents of percutaneous nephrostomy suggest that drainage is improved with the larger sized nephro-stomy tube and that complications related to manipulation of a stent across the area of blockage are eliminated i.e., ureteral perforation . In addition, percutaneous nephrostomy can be performed under local anesthesia, which is a true benefit for many patients. In some institutions...

Paraphimosis and Phimosis

Boy Phimosis

Paraphimosis is a frequently encountered condition in the pediatric emergency department. Because of their age and lack of understanding, children have a tendency to neglect to reduce their foreskin following retraction at the time of micturition. Occasionally medical personnel will cause an iatrogenic paraphimosis by inadvertently leaving the foreskin retracted following insertion of an indwelling urethral catheter. Subsequent edema and venous congestion proximally could lead to decreased...