This case describes a patient presenting with AKI, loin pain, pyrexia and unilateral hydronephrosis secondary to obstructing sloughed papilla. It demonstrates the importance of considering alternative causes of radiolucent obstructive uropathy in patients with poorly controlled diabetes mellitus especially where there are risk factors for renal papillary necrosis.
{"title":"Obstructive Pyelonephritis in a Diabetic … Think Sloughed Papilla!","authors":"S. Mason, D. Good, F. Jaafari","doi":"10.22374/JELEU.V1I1.11","DOIUrl":"https://doi.org/10.22374/JELEU.V1I1.11","url":null,"abstract":"This case describes a patient presenting with AKI, loin pain, pyrexia and unilateral hydronephrosis secondary to obstructing sloughed papilla. It demonstrates the importance of considering alternative causes of radiolucent obstructive uropathy in patients with poorly controlled diabetes mellitus especially where there are risk factors for renal papillary necrosis. ","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133447164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Impassable ureteric obstruction (benign or malignant) can cause a real challenge to every endoluminal endourologist. Usually a percutaneous nephrostomy is the initial approach to drain the obstructed kidney and often becomes the long term option if reconstruction is not possible. We describe the case of a patient awaiting cardiovascular repair for severe valvular disease who was denied surgery due to his long term nephrostomy for an impassable ureter. His nephrostomy was internalised via an extra-anatomical subcutaneous tract into the bladder using a Patterson-Forrester stent ridding him of the tube and allowing him to be listed for life saving heart surgery. Following heart surgery his fitness will be reassessed and definitive treatment will be planned accordingly.
{"title":"“Caught between a Rock and a Hard Place” – Until the Patterson Forester Extra Anatomic Stent Bailed Us Out","authors":"D. Good, S. Pillai, F. Jaafari","doi":"10.22374/JELEU.V1I1.8","DOIUrl":"https://doi.org/10.22374/JELEU.V1I1.8","url":null,"abstract":"Impassable ureteric obstruction (benign or malignant) can cause a real challenge to every endoluminal endourologist. Usually a percutaneous nephrostomy is the initial approach to drain the obstructed kidney and often becomes the long term option if reconstruction is not possible. We describe the case of a patient awaiting cardiovascular repair for severe valvular disease who was denied surgery due to his long term nephrostomy for an impassable ureter. His nephrostomy was internalised via an extra-anatomical subcutaneous tract into the bladder using a Patterson-Forrester stent ridding him of the tube and allowing him to be listed for life saving heart surgery. Following heart surgery his fitness will be reassessed and definitive treatment will be planned accordingly.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131593138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We describe a novel technique of performing a retrograde pyelogram through a 4.8 French multi-length stent. This was used in a female with an upper ureteric pinhole stricture which was impassable with a standard 6 French ureteric catheter, who required a retrograde pyelogram to confirm correct stent position. This technique was effective and conferred no additional cost to the procedure.
{"title":"A Novel Technique for Performing Retrograde Pyelogram through a Ureteric Stent","authors":"J. Cobley, W. Mahmalji","doi":"10.22374/JELEU.V1I1.2","DOIUrl":"https://doi.org/10.22374/JELEU.V1I1.2","url":null,"abstract":"We describe a novel technique of performing a retrograde pyelogram through a 4.8 French multi-length stent. This was used in a female with an upper ureteric pinhole stricture which was impassable with a standard 6 French ureteric catheter, who required a retrograde pyelogram to confirm correct stent position. This technique was effective and conferred no additional cost to the procedure.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125026108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-01DOI: 10.1016/S1569-9056(17)30524-9
I. Akbarov, M. Al-Mahmid, D. Pfister, V. Zugor, A. Tok, A. Heidenreich
{"title":"Upper Urinary Tract Decompression Using Ileal Ureter Replacement (IUR) In Comparison to Endoureteral Thermoexpandable Stent [Memokath® 051]","authors":"I. Akbarov, M. Al-Mahmid, D. Pfister, V. Zugor, A. Tok, A. Heidenreich","doi":"10.1016/S1569-9056(17)30524-9","DOIUrl":"https://doi.org/10.1016/S1569-9056(17)30524-9","url":null,"abstract":"","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122396082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madeline Moore, A. Robinson, M. Kitchen, L. Gommersall
BackgroundDespite National Institute for Clinical Excellence (NICE) guidelines suggesting the use of urine cytology (UC) for the diagnosis of bladder cancer, its use is variable. Reasons for this include sub-optimal sensitivity, financial cost, availability of alternative tests, and uncertainty over interpretation of results. Anecdotally, however, suspicious or malignant UC when other investigations are normal, occasionally leads to a cancer diagnosis. Therefore, we retrospectively assessed a cohort of our haematuria patients to determine the value of UC in cancer diagnosis and the clinical significance of atypical UC (graded as C3). Patients and methodsWe identified 3018 patients with haematuria referred on the suspected cancer pathway (“two-week wait”) in 2015. We retrospectively analysed clinical, demographic, and follow-up/outcome data in a random cohort of 500 cases. ResultsMedian follow up was 58 months. Urological malignancy was diagnosed in 61/500 patients; all were identified by cystoscopy or imaging, i.e., irrespective of UC result. No cases of atypical UC re-presented with a ‘missed’ cancer diagnosis within the five-year follow-up period. However, suspicious and malignant cytology was associated with high-grade/aggressive tumours and subsequent tumour recurrence. ConclusionUrine cytology did not identify any cancers that were not already found by imaging or cystoscopy. Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for transurethral resection of bladder tumour (TURBT), however, it is unclear whether this might benefit patient outcomes. We conclude therefore that UC has no role in haematuria investigations.
{"title":"Should National Institute for Clinical Excellence (NICE) Guidelines Remove Urine Cytology as a Suggested Adjunct in Suspected Bladder Cancer (haematuria) Investigations?","authors":"Madeline Moore, A. Robinson, M. Kitchen, L. Gommersall","doi":"10.22374/jeleu.v4i3.126","DOIUrl":"https://doi.org/10.22374/jeleu.v4i3.126","url":null,"abstract":"BackgroundDespite National Institute for Clinical Excellence (NICE) guidelines suggesting the use of urine cytology (UC) for the diagnosis of bladder cancer, its use is variable. Reasons for this include sub-optimal sensitivity, financial cost, availability of alternative tests, and uncertainty over interpretation of results. Anecdotally, however, suspicious or malignant UC when other investigations are normal, occasionally leads to a cancer diagnosis. Therefore, we retrospectively assessed a cohort of our haematuria patients to determine the value of UC in cancer diagnosis and the clinical significance of atypical UC (graded as C3). \u0000Patients and methodsWe identified 3018 patients with haematuria referred on the suspected cancer pathway (“two-week wait”) in 2015. We retrospectively analysed clinical, demographic, and follow-up/outcome data in a random cohort of 500 cases. \u0000ResultsMedian follow up was 58 months. Urological malignancy was diagnosed in 61/500 patients; all were identified by cystoscopy or imaging, i.e., irrespective of UC result. No cases of atypical UC re-presented with a ‘missed’ cancer diagnosis within the five-year follow-up period. However, suspicious and malignant cytology was associated with high-grade/aggressive tumours and subsequent tumour recurrence. \u0000ConclusionUrine cytology did not identify any cancers that were not already found by imaging or cystoscopy. Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for transurethral resection of bladder tumour (TURBT), however, it is unclear whether this might benefit patient outcomes. We conclude therefore that UC has no role in haematuria investigations.","PeriodicalId":136362,"journal":{"name":"Journal of Endoluminal Endourology","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128438095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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