Pyonephrosis and urosepsis in a 41-year old patient with spina bifida: Case report of a preventable death

Abstract

BackgroundUrological complications are the major cause of ill health in patients with spina bifida. Urinary sepsis accounted for the majority of admissions in patients with spina bifida. As the patient grows older, changes occur in the adult bladder, leading to increases in storage pressure and consequent risk of deterioration of renal function, which may occur insidiously.Case presentationA 34-year-old male spinal bifida patient had been managing neuropathic bladder by penile sheath. Intravenous urography revealed normal kidneys. This patient was advised intermittent catheterisations. But self-catheterisation was not possible because of long, overhanging prepuce and marked spinal curvature. This patient developed repeated urine infections. Five years later, ultrasound examination of urinary tract revealed hydronephrotic right kidney with echogenic debris within the collecting system. There was no evidence of dilatation of the ureter near the vesicoureteric junction. The left kidney appeared normal. There was no evidence of calculus disease seen in either kidney. Indwelling urethral catheter drainage was established.Two years later, MAG-3 renogram revealed normal uptake and excretion by left kidney. The right kidney showed little functioning tissue. Following a routine change of urethral catheter this patient became unwell. Ultrasound examination revealed hydronephrotic right kidney containing thick hyper-echoic internal septations and debris in the right renal pelvis suspicious of pyonephrosis. Under both ultrasound and fluoroscopic guidance, an 8 French pig tail catheter was inserted into the right renal collecting system. 150 ml of turbid urine was aspirated immediately. This patient developed large left pleural effusion, collapse/consolidation of the left lower lobe, a large fluid collection in the abdomen extending into the pelvis and expired twenty days later because of sepsis and respiratory failure.ConclusionAlthough penile sheath drainage may be convenient for a spina bifida patient and the carers, hydronephrosis can occur insidiously. With recurrent urine infections, hydronephrotic kidney can become pyonephrosis, which is life-threatening. Therefore, every effort should be made to carry out intermittent catheterisations along with antimuscarinic drug therapy.

Neurourological complications in patients with myelodisplasia

“…Mesane augmentasyon operasyonu için endikasyonlar yüksek depolama basıncı (>%40), üriner inkontinansın perzistansı, detrüsör aşırı aktivitesi ve düşük kompliyans olarak sıralanabilir [12].Bu ameliyatın sosyal kontinansın önem kazandığı 5 yaş üzerinde tavsiye edildiği ve yapılan çalışmalarda ortalama yaşın 8-12 olduğu görülmektedir [13]. Ancak konjenital mesane anomalisi olan bir hastada ileal ve kolonik segmentin augmentasyonun, normal popülasyona göre 7-8 kat, gastrik augmentasyonun ise 14-15 kat artmış mesane kanseri riski oluşturduğu unutulmamalıdır [14].…”

“…Yapılan bir çalışmada taburculuklarından sonraki ilk 30 gün içinde hastaneye tekrar başvurma riskleri yüksek bulunmuştur [18]. Çocukluk ve yetişkinlik döneminde ürolojik komplikasyonlar sağlığı bozan majör nedenlerden olmakla birlikte hem bireyler hem de sağlık hizmeti veren merkezlerin bunun önemini olması gerektiği noktada tutamadıkları görülmektedir [14].…”

The 5th anniversary of “Patient Safety in Surgery” – from the Journal’s origin to its future vision

“…Strikingly, we were astonished by the unexpected high submission rate of case reports on surgical complications, preventable sentinel events, and “never events”, starting from the first weeks of the journal’s launch [6,7], until the present day [8,9]. This impressive fact supports the notion that health care providers all over the globe appear to strive to publicly report, analyze, and discuss root causes and preventive measures of adverse events which lead to unnecessary patient harm, in order to provide more transparency to other health care providers, and to the public.…”

Analysis of Nephrolithiasis Treatment in Highest Reference Hospital—Occurrence of Acromegaly in the Study Group

“…Such changes may remain asymptomatic for many years or cause severe pain and kidney dysfunction. One of the most dangerous complications may be pyonephrosis which can lead to organ loss or even death [ 2 , 3 ]. Urolithiasis is characterized by a relatively high prevalence of 4.4–10.1% depending on the population [ 4 , 5 ], as well as a high risk of recurrence estimated up to 50% over 10 years [ 6 ].…”