No abstract

Objective Patients with ureteral calculi and systemic inflammatory response syndrome (SIRS) often require emergency drainage, and percutaneous nephrostomy (PCN) and retrograde ureteral stent insertion (RUSI) are the most commonly used methods. Our study aimed to identify the best choice (PCN or RUSI) for these patients and to examine the risk factors for progression to urosepsis after decompression. Methods A prospective, randomized clinical study was performed at our hospital from March 2017 to March 2022. Patients with ureteral stones and SIRS were enrolled and randomized to the PCN or RUSI group. Demographic information, clinical features and examination results were collected. Results Patients ( n = 150) with ureteral stones and SIRS were enrolled into our study, with 78 (52%) patients in the PCN group and 72 (48%) patients in the RUSI group. Demographic information was not significantly different between the groups. The final treatment of calculi was significantly different between the two groups ( p < .001). After emergency decompression, urosepsis developed in 28 patients. Patients with urosepsis had a higher procalcitonin ( p = .012) and blood culture positivity rate ( p < .001) and more pyogenic fluids during primary drainage ( p < .001) than patients without urosepsis. Conclusion PCN and RUSI were effective methods of emergency decompression in patients with ureteral stone and SIRS. Patients with pyonephrosis and a higher PCT should be carefully treated to prevent the progression to urosepsis after decompression. Key message In this study, we evaluate the best choice (PCN or RUSI) for patients who have ureteral stones and SIRS and to examine the risk factors for progression to urosepsis after decompression. This study found that PCN and RUSI were effective methods of emergency decompression. Pyonephrosis and higher PCT were risk factors for patients to develop to urosepsis after decompression.

To evaluate whether the higher attenuation value [Hounsfield unit (HU)] in non-contrast CT can predict pyonephrosis in patients with upper urinary tract stones (UTS). Between October 2019 and October 2021, patients with hydronephrosis or pyonephrosis secondary to upper UTS were retrospectively searched in our study. All patients with UTS were treated with percutaneous nephrostomy, percutaneous nephrolithotomy, retrograde ureteral stent or transurethral ureteroscope lithotripsy. We excluded patients treated with extracorporeal shock-wave lithotripsy. Patients whose CT was not performed in our hospital or treated in another hospital were also excluded. Clinical data regarding basic information, clinical feature, Calculi-related indicators, HU values of the renal pelvis, the thick wall of the renal pelvis on CT were collected. Univariate and multivariate logistic analyses were performed. Receiver operative characteristic curves were drawn to predict pyonephrosis. A total of 240 patients with UTS were retrospected in this research, 191 patients had hydronephrosis (Group 1), and 49 patients had hydronephrosis with pyonephrosis (Group 2). The HU value of the renal collecting system in Group 2 (mean, 15.46; range, +1/+30) was significantly higher than that in Group 1 (mean, 5.5; 5 range −6/+24) ( P = .02); the receiver operative characteristic curve analysis revealed that the best cut-off value of 9.5 could predict the presence of pyonephrosis, with 71.4% sensitivity and 70.2% specificity (area under the curve = 0.613; 95% CI: 0.514–0.713). In this study, we found the HU attenuation value of the renal collecting system can be used to distinguish pyonephrosis from hydronephrosis in patients with UTS.

BackgroundUreteral Fibroepithelial Polyps (UFPs) are benign tumors that arise from the mesodermal layer. The disease is a rare cause of ureteropelvic junction obstruction (UPJO), particularly in children. Case presentationwe present a case of a child preoperatively diagnosed with UPJO and urogenic sepsis owing to horseshoe kidney using magnetic resonance imaging(MRI). During surgery, we found that the ureteral polyp rather than the horseshoe kidney was the cause of the PUJO.Thenus, the ureteral polyp was resected, and end-to-end anastomosis was performed with the renal pelvis and ureters. An F5 double J tube was indwelling and removed by ureteroscopy three months later. No special adverse events were found during 1-year follow-up. ConclusionsWhen the clinical and radiographic findings of the patient are incompatible with the common etiology, ureteral fibroepithelial polyps should be considered as a rare cause of PUJO.