Search

Introduction/objective: Advances in ureteroscope design and refinements of ancillary instrumentation have resulted in an expanded role for ureteroscopy in the management of urinary calculi. Technological enhancements coupled with improved endourologic skills have also been associated with a reduction in procedural-related complications. Historically, postoperative imaging with ultrasound (U/S) or intravenous pyelogram (IVP) had been advocated to rule out persistent obstruction due to retained stone fragments or ureteral stricture. The purposes of this study were to evaluate the incidence of postoperative ureteral obstruction in a contemporary series of patients undergoing ureteroscopic holmium:YAG laser lithotripsy without basket extraction of fragments and to identify patient, stone and operative factors predictive of which patients will benefit from postoperative imaging., Materials and Methods: The charts and imaging studies of 89 consecutive patients undergoing a total of 94 holmium:YAG ureteroscopic lithotripsy procedures between December 1998 and December 2000 were retrospectively reviewed. Preoperative, intraoperative and postoperative data were collected and analyzed. The primary outcome measure was the incidence of postoperative ureteral obstruction documented on upper tract imaging. Secondary outcome measures included interventions required for postoperative obstruction and other nonobstructive postoperative complications., Results: Twenty-eight females and 61 males were studied, with a mean patient age of 54 (range 13-80) years. Fifty-five percent of patients underwent related procedures prior to referral to our tertiary endourology centre. Complete clinical and radiological follow-up is available for 68 of 89 (76.4%) patients, with a mean follow-up duration of 24.2 weeks. Overall stone-free rate was 97%. Six patients had evidence of urinary tract obstruction on follow-up radiological assessment, two from residual stone fragments and four from ureteral stricture. Each of these four patients had at least one preoperative risk factor for ureteral stricture., Conclusions: Routine postoperative upper tract imaging is not necessary in all patients undergoing uncomplicated ureteroscopic holmium:YAG laser lithotripsy. Indications for upper tract imaging include chronic stone impaction, significant ureteral trauma, pre-existing renal function impairment, endoscopic evidence of stricture and postoperative flank pain or fever.

A case of hydrocele infection secondary to a cutaneous b-hemolytic group A streptococcal infection is described in a renal transplant recipient. Sepsis and renal failure occurred in the setting of this severe, life-threatening infection. This case represents the first description of a group A streptococcal hydrocele infection in an adult. This type of infection can progress rapidly to sepsis and its attendant complications, especially in an immunocompromised patient. Early diagnosis and treatment is crucial in order to optimize the outcome.

Since the introduction and widespread use of extracorporeal shockwave lithotripsy (SWL), various complications have been noted. Perinephric hematoma and ureteral obstruction may be anticipated by urologists as potential problems. We report the first case of perinephric abscess encountered after 17 895 SWL treatments at our institution. A 65 year old woman presented 4 months following a second SWL procedure with a perinephric abscess and was successfully treated with percutaneous drainage. A review of the English literature revealed only 3 other cases of perinephric abscess following SWL. This diagnosis should be considered in early and late presentations of flank pain following SWL.

Appendicovesical fistulae are rare and occur secondary to acute or missed acute appendicitis. A 15 year old boy presented with urinary symptoms and a pelvic abscess on imaging studies. At laparotomy an appendicovesical fistula was encountered and was successfully managed by a right colectomy and ileal transverse colon anastomosis. The presentation and management of appendicovesical fistula is discussed.