Introduction: Obstructive uropathies refer to anatomical impediments to normal urinary flow. They are predominantly caused by congenital malformations of the urinary tract and occasionally complicated by obstructive u...Introduction: Obstructive uropathies refer to anatomical impediments to normal urinary flow. They are predominantly caused by congenital malformations of the urinary tract and occasionally complicated by obstructive urinary stones. This study aims to elucidate the epidemiological and diagnostic facets of obstructive uropathies. Patients and Method: This retrospective, descriptive study was conducted over six years, from January 1, 2018, to December 31, 2023, at the pediatric surgery department of Albert Royer Children’s Hospital in Dakar, Senegal. The study focused on the frequency of obstructive uropathies, the sex ratio, discovery contexts, types and locations of uropathies, and associated malformations. Results: Among the 29,935 children received in the department during the study period, 130 cases of obstructive uropathies were documented, equating to a hospital incidence of 0.43%. The mean age of patients was 42.53 months, ranging from one day to 15 years. Infants constituted the largest affected group, at 47.69%. The cohort included 106 males and 24 females, rendering a sex ratio of 4.41. The antenatal diagnosis was confirmed in 27 patients (20%). Uretero-hydronephrosis emerged as the predominant clinical indication. Postnatally, urinary disorders prompted consultation in 36% of cases. Ultrasound examinations were performed universally. Additionally, VUCG was conducted in 49% of patients to identify lower urinary tract obstructions, while 39% underwent urological CT scan for upper tract obstruction etiology. Renal distress with electrolyte imbalance was evident in 8% of cases. Concurrent urogenital pathologies were present in 18% of cases. Notably, posterior urethral valves accounted for 39%, pyeloureteric junction obstruction for 31%, obstructive caliceal and pelvic lithiasis at 8%, and obstructive ureteral lithiasis at 6%. Other obstruction causes included obstructive megaureter on simple systems (3%), ectopic ureter in duplex systems (2%), urethral stenosis (2%), obstructive urethral lithiasis (2%), obstructive bladder lithiasis (2%), obstructive megaureter in duplex systems (1%), ureterocele in duplex systems (1%), ureteral stenosis (1%), and ureterocele with obstructive bladder lithiasis (1%). Conclusion: Predominantly malformative in origin, obstructive uropathies necessitate ultrasound of the urinary tract as a primary diagnostic tool. Their etiologies are posterior urethral valves, pyeloureteric junction obstruction, and obstructive urolithiasis.展开更多
Obstructive uropathy represents a major risk of acute kidney injury.From an epidemiological point of view,it is responsible for 5%to 10%of cases of acute renal failure and 4%of cases of end-stage kidney disease.Althou...Obstructive uropathy represents a major risk of acute kidney injury.From an epidemiological point of view,it is responsible for 5%to 10%of cases of acute renal failure and 4%of cases of end-stage kidney disease.Although obstructive uropathy is a recognized disease,there is a significant lack of detailed research on this topic from both a nephrological and urological perspective.The majority of published research focuses on the pathophysiology of the topic and neglects a comprehensive analysis of diagnostic and treatment approaches supported by current data.In this context,it is crucial to assess the overall hemodynamic status,especially in the presence of urosepsis.Once clinical stability is assured,it is important to focus on symptom management,usually by controlling pain.Ultimately,it is crucial to decide immediately whether the patient should receive a prompt urinary diversion.Urinary diversion is an essential part of the treatment of obstructive uropathy and should be initiated promptly and without unnece-ssary delay once the diagnosis has been confirmed.Functional recovery of the obstructed kidney after decompression of the urinary tract depends on the degree of obstruction,the duration of the obstruction and the presence of a concomitant urinary tract infection.The timing and proper treatment of this condition determines the recovery of kidney function after an obstruction and prevents the development of chronic kidney disease.In this editorial,we emphasized the pathophysiological role and clinical significance of obstructive uropathy in the context of acute kidney injury.展开更多
Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract.It is regarded as one of the most prevalent causes of acute kidney injury(AKI),accounti...Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract.It is regarded as one of the most prevalent causes of acute kidney injury(AKI),accounting for 5%–10%of cases.Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction.The aim of the present article is to review and synthesize available evidence on obstructive uropathy,providing a clinical guideline for clinicians.A literature review on obstructive uropathy in the context of AKI was performed,focusing on the least clarified aspects regarding diagnosis and management.Recent literature searching was conducted in English and top-level evidence articles including systematic reviews,metanalyses and large series were prioritized.Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney.Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection.A multidisciplinary approach,including urologists,nephrologists,and other medical specialties,is best suited to correctly manage concomitant hemodynamic changes,fluid and electrolyte imbalances,and other related issues.Obstructive uropathy is one of the leading causes of AKI.Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challeng-ing.A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.展开更多
Obstructive uropathy is an important cause of acute and chronic kidney disease.Decompression of the urinary tract is an essential aspect of treatment.The cause and aetiology of obstruction typically determine the surg...Obstructive uropathy is an important cause of acute and chronic kidney disease.Decompression of the urinary tract is an essential aspect of treatment.The cause and aetiology of obstruction typically determine the surgical approach.Acute relief of obstruction is frequently complicated by fluid and electrolyte imbalance.Standard therapeutic interventions for acute or chronic renal failure also apply for cases of obstructive uropathy.This narrative review summarises the early and long-term medical management of obstructive uropathy.展开更多
BACKGROUND: Acute renal failure(ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But...BACKGROUND: Acute renal failure(ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive.METHODS: We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy(SWL) for dissolution of calculi.RESULTS: The patient was successfully treated, and reported asymptomatic in a follow-up.CONCLUSION: Close collaboration between nephrological, urological, and radiological services is required.展开更多
Background:Stevens-Johnson Syndrome(SJS)is an acute mucocutaneous eruption with blisters of the skin and haemorrhagic erosions of mucous membranes.This report describes air-leak syndrome and obstructive uropathy occur...Background:Stevens-Johnson Syndrome(SJS)is an acute mucocutaneous eruption with blisters of the skin and haemorrhagic erosions of mucous membranes.This report describes air-leak syndrome and obstructive uropathy occurring simultaneously in a teenage patient affected by SJS.Case presentation:A 17-year-old Malay female with SJS suffered from bilateral pneumothoraces,pneumomediastinum,and obstructive uropathy as early complications of her disease.She required intubation,chest tube insertion,and bilateral ureteric stenting as part of her intensive care management.These extracutaneous complications of renal and pulmonary systems were likely secondary to widespread epithelial detachment.Conclusion:Despite paucity of cases in adult literature,post-renal causes for acute kidney injury must be considered in SJS,especially in the setting of gross haematuria.Bedside point-of-care ultrasonography may be a useful tool for excluding obstructive uropathy.Pneumothorax is a rare but documented complication of SJS in paediatric cases and,to a lesser extent,adult patients.Extra care should be exercised when caring for mechanically ventilated patients suffering from SJS.展开更多
Objectives:This study is aimed to determine the impact of liver disease severity on the outcome of patients undergoing endourological procedures for urolithiasis,and to understand the factors that are helpful in impro...Objectives:This study is aimed to determine the impact of liver disease severity on the outcome of patients undergoing endourological procedures for urolithiasis,and to understand the factors that are helpful in improving the outcome.Materials and methods:We retrospectively analyzed the records of patients with chronic liver disease who underwent endourological procedures between January 2014 and February 2020.Inpatient records and charts were assessed for age,sex,height,weight,body mass index,model for end-stage liver disease(MELD)score,Child-Turcotte-Pugh score,type of procedure and anesthesia,intensive care unit(ICU)stay,duration of hospitalization,number,size,and position of stones,and postoperative complications such as hematuria,sepsis,and secondary procedures.Data are presented as mean±standard deviation or frequency.The chi-square test was applied to determine the exact association between categorical data and Student t-test or Mann-Whitney U test as appropriate for continuous data.Statistical significance was set at p<0.05.Results:Hospital and ICU stay as well as administration of different blood products were significantly longer in the Child C than in the Child A and B categories(p<0.001).Two patients in the Child C category died,while 3 left the hospital against medical advice.The duration of ICU stay and blood products administered increased with augmenting MELD scores.The durations of hospitalization and blood product administration were significantly higher in patients with an MELD score≥20 than in the group with MELD score<20.Conclusions:Hospital and ICU stay and blood product administration were significantly higher in Child C than in Child A and B class patients.Hospitalization duration and blood product administration were significantly higher in patients with an MELD score≥20.展开更多
文摘Introduction: Obstructive uropathies refer to anatomical impediments to normal urinary flow. They are predominantly caused by congenital malformations of the urinary tract and occasionally complicated by obstructive urinary stones. This study aims to elucidate the epidemiological and diagnostic facets of obstructive uropathies. Patients and Method: This retrospective, descriptive study was conducted over six years, from January 1, 2018, to December 31, 2023, at the pediatric surgery department of Albert Royer Children’s Hospital in Dakar, Senegal. The study focused on the frequency of obstructive uropathies, the sex ratio, discovery contexts, types and locations of uropathies, and associated malformations. Results: Among the 29,935 children received in the department during the study period, 130 cases of obstructive uropathies were documented, equating to a hospital incidence of 0.43%. The mean age of patients was 42.53 months, ranging from one day to 15 years. Infants constituted the largest affected group, at 47.69%. The cohort included 106 males and 24 females, rendering a sex ratio of 4.41. The antenatal diagnosis was confirmed in 27 patients (20%). Uretero-hydronephrosis emerged as the predominant clinical indication. Postnatally, urinary disorders prompted consultation in 36% of cases. Ultrasound examinations were performed universally. Additionally, VUCG was conducted in 49% of patients to identify lower urinary tract obstructions, while 39% underwent urological CT scan for upper tract obstruction etiology. Renal distress with electrolyte imbalance was evident in 8% of cases. Concurrent urogenital pathologies were present in 18% of cases. Notably, posterior urethral valves accounted for 39%, pyeloureteric junction obstruction for 31%, obstructive caliceal and pelvic lithiasis at 8%, and obstructive ureteral lithiasis at 6%. Other obstruction causes included obstructive megaureter on simple systems (3%), ectopic ureter in duplex systems (2%), urethral stenosis (2%), obstructive urethral lithiasis (2%), obstructive bladder lithiasis (2%), obstructive megaureter in duplex systems (1%), ureterocele in duplex systems (1%), ureteral stenosis (1%), and ureterocele with obstructive bladder lithiasis (1%). Conclusion: Predominantly malformative in origin, obstructive uropathies necessitate ultrasound of the urinary tract as a primary diagnostic tool. Their etiologies are posterior urethral valves, pyeloureteric junction obstruction, and obstructive urolithiasis.
文摘Obstructive uropathy represents a major risk of acute kidney injury.From an epidemiological point of view,it is responsible for 5%to 10%of cases of acute renal failure and 4%of cases of end-stage kidney disease.Although obstructive uropathy is a recognized disease,there is a significant lack of detailed research on this topic from both a nephrological and urological perspective.The majority of published research focuses on the pathophysiology of the topic and neglects a comprehensive analysis of diagnostic and treatment approaches supported by current data.In this context,it is crucial to assess the overall hemodynamic status,especially in the presence of urosepsis.Once clinical stability is assured,it is important to focus on symptom management,usually by controlling pain.Ultimately,it is crucial to decide immediately whether the patient should receive a prompt urinary diversion.Urinary diversion is an essential part of the treatment of obstructive uropathy and should be initiated promptly and without unnece-ssary delay once the diagnosis has been confirmed.Functional recovery of the obstructed kidney after decompression of the urinary tract depends on the degree of obstruction,the duration of the obstruction and the presence of a concomitant urinary tract infection.The timing and proper treatment of this condition determines the recovery of kidney function after an obstruction and prevents the development of chronic kidney disease.In this editorial,we emphasized the pathophysiological role and clinical significance of obstructive uropathy in the context of acute kidney injury.
文摘Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract.It is regarded as one of the most prevalent causes of acute kidney injury(AKI),accounting for 5%–10%of cases.Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction.The aim of the present article is to review and synthesize available evidence on obstructive uropathy,providing a clinical guideline for clinicians.A literature review on obstructive uropathy in the context of AKI was performed,focusing on the least clarified aspects regarding diagnosis and management.Recent literature searching was conducted in English and top-level evidence articles including systematic reviews,metanalyses and large series were prioritized.Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney.Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection.A multidisciplinary approach,including urologists,nephrologists,and other medical specialties,is best suited to correctly manage concomitant hemodynamic changes,fluid and electrolyte imbalances,and other related issues.Obstructive uropathy is one of the leading causes of AKI.Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challeng-ing.A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.
文摘Obstructive uropathy is an important cause of acute and chronic kidney disease.Decompression of the urinary tract is an essential aspect of treatment.The cause and aetiology of obstruction typically determine the surgical approach.Acute relief of obstruction is frequently complicated by fluid and electrolyte imbalance.Standard therapeutic interventions for acute or chronic renal failure also apply for cases of obstructive uropathy.This narrative review summarises the early and long-term medical management of obstructive uropathy.
文摘BACKGROUND: Acute renal failure(ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive.METHODS: We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy(SWL) for dissolution of calculi.RESULTS: The patient was successfully treated, and reported asymptomatic in a follow-up.CONCLUSION: Close collaboration between nephrological, urological, and radiological services is required.
文摘Background:Stevens-Johnson Syndrome(SJS)is an acute mucocutaneous eruption with blisters of the skin and haemorrhagic erosions of mucous membranes.This report describes air-leak syndrome and obstructive uropathy occurring simultaneously in a teenage patient affected by SJS.Case presentation:A 17-year-old Malay female with SJS suffered from bilateral pneumothoraces,pneumomediastinum,and obstructive uropathy as early complications of her disease.She required intubation,chest tube insertion,and bilateral ureteric stenting as part of her intensive care management.These extracutaneous complications of renal and pulmonary systems were likely secondary to widespread epithelial detachment.Conclusion:Despite paucity of cases in adult literature,post-renal causes for acute kidney injury must be considered in SJS,especially in the setting of gross haematuria.Bedside point-of-care ultrasonography may be a useful tool for excluding obstructive uropathy.Pneumothorax is a rare but documented complication of SJS in paediatric cases and,to a lesser extent,adult patients.Extra care should be exercised when caring for mechanically ventilated patients suffering from SJS.
文摘Objectives:This study is aimed to determine the impact of liver disease severity on the outcome of patients undergoing endourological procedures for urolithiasis,and to understand the factors that are helpful in improving the outcome.Materials and methods:We retrospectively analyzed the records of patients with chronic liver disease who underwent endourological procedures between January 2014 and February 2020.Inpatient records and charts were assessed for age,sex,height,weight,body mass index,model for end-stage liver disease(MELD)score,Child-Turcotte-Pugh score,type of procedure and anesthesia,intensive care unit(ICU)stay,duration of hospitalization,number,size,and position of stones,and postoperative complications such as hematuria,sepsis,and secondary procedures.Data are presented as mean±standard deviation or frequency.The chi-square test was applied to determine the exact association between categorical data and Student t-test or Mann-Whitney U test as appropriate for continuous data.Statistical significance was set at p<0.05.Results:Hospital and ICU stay as well as administration of different blood products were significantly longer in the Child C than in the Child A and B categories(p<0.001).Two patients in the Child C category died,while 3 left the hospital against medical advice.The duration of ICU stay and blood products administered increased with augmenting MELD scores.The durations of hospitalization and blood product administration were significantly higher in patients with an MELD score≥20 than in the group with MELD score<20.Conclusions:Hospital and ICU stay and blood product administration were significantly higher in Child C than in Child A and B class patients.Hospitalization duration and blood product administration were significantly higher in patients with an MELD score≥20.
