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Introduction. Hospital strains of microorganisms are characterized by multiple drug resistance, which significantly complicates treatment of infectious and inflammatory diseases acquired by patients during hospitalization, especially in the postoperative period. One of the methods of decreasing the level of hospital-acquired urinary tract infections (HAUTI) in urological in-patient facilities is antibacterial prevention prior to various interventions and surgeries.The study objective is to investigate the effectiveness of pre- and postoperative use of fluoroquinolones in prevention of inflammatory complications of interventional and focal treatment methods in uro-andrology.Materials and methods. The study included 32 patients aged 18 to 70 years (mean age 48.9 ± 12 years). All patients received antibacterial prevention in the pre- and postoperative periods. The patients were divided into 3 groups. In the 1st group (n = 10), all patients underwent prostate biopsy, including transrectal multifocal biopsy in 5 patients, template biopsy in 3 patients, and fusion biopsy in 2 patients. In the 2nd group (n = 12), all patients underwent prostatic artery embolization for benign prostatic hyperplasia and intermediate-to-severe lower urinary tract symptoms. In the 3rd group, 10 patients with nephrolithiasis underwent nephrolithotomy without retrograde pyelography.Results. In the 1st group, mean patient age was 66 ± 5.4 years (59–78 years); total score per the International Scoring Prognostic System (IPSS) was 18.7 ± 3.4; mean leukocyte count was 3.2 ± 1.1 per field of vision (FOV); score per the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) for evaluation of chronic prostatitis/chronic pelvic pain syndrome was 19.3 ± 5.7; score per the visual analog scale (VAS) was 4.3 ± 1.2. In 7 patients (70 %), prostate fluid (PF) contained more than 10–15 leukocytes per FOV, in 3 patients (10 %) less than 10 leukocytes. Positive inoculations were observed in 6 patients, Enterobacteriaceae family microorganism sensitivity (microbial count 105 CFU/ml) – in 2, E. сoli sensitivity (105) – in 2, Staphylococcus aureus sensitivity (104) – in 2; the rest of inoculations were negative. PF examination revealed 10–15 leukocytes per FOV in 4 patients, less than 10 leukocytes in 5 patients. In the 2nd group, PF inoculations demonstrated the following positive reactions: E. сoli (104) in 3 patients, Staphylococcus aureus (104) in 2 patients; in other inoculations no microflora growth was observed. No inflammatory complications in the postoperative period were evident. Macrohematuria developed in 3 patients, transient blood in stool in 2 patients. In the postoperative period, there weren’t any data on the presence of flora from patients. The 3rd group included 6 men and 4 women with nephrolithiasis (aged from 34 to 58 years, mean age 47 ± 7.4 years), who underwent percutaneous nephrolithotomy. The patients displayed various concrements in the kidneys (2 recurrent) and ureter. In most patients (8), leukocyturia was diagnosed: from 15 leukocytes per FOV to “dense, whole FOV”; positive inoculations in 7 patients; flora sensitivity to Lefokcin in 5 patients; Enterobacteriaceae family microorganism sensitivity (105) – in 2, E. сoli sensitivity (105) – in 2, Staphylococcus aureus sensitivity (104) – in 1; no microflora growth was observed in other inoculations.Conclusion. Treatment effectiveness in the studied groups was associated with eradication of the causative agent (empirical antibacterial therapy with correction after inoculation (fluoroquinolones), high safety profile, inhibiting concentration in the urologic organs (hematoprostatic and hematotesticular barriers) [1], wide spectrum of action, low probability of development of torpid forms of causative agents, and low level of side effects (hepatotoxicity, effect on spermatogenesis)). Empirical therapy, i.e. treatment until acquirement of microbiological data for a certain patient, plays a crucial role in treatment of urogenital infections. Choice of starting regimen of antibacterial therapy must be based on the local microbiological monitoring data and take into account the spectrum of urinary infection causative agents and their resistance to antibiotics. On the pharmaceutical market, levofloxacin is represented by several drugs, one of which is Lefokcin manufactured by Shreya Life Sciences. It’s an effective antibacterial drug for prevention and postoperative management of patients who underwent interventional and focal diagnostic and treatment procedures of uro-andrology.

Objective: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. Methods: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. Results: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. Conclusion: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.

Iatrogenic ureteral injuries are a dramatic complication in medical practice. Nowadays there are no universal guidelines for their management. The aim of our study was to evaluate the feasibility of the percutaneous treatment in restoring ureteral integrity in 19 patients that came to our attention. In each case retrograde stenting failed and patients were candidates for re-surgery. Our strategy consists of two phases. The first step is the nephrostomy that allows an external urinary diversion putting dry the damaged ureteral segment. The second step is the anterograde ureteral double-J stenting that keeps near the two stumps promoting the healing of the injured tract. In complete sections, when both retrograde and anterograde stenting singularly failed, we performed a rendez-vous technique with a combined radiological trans-nephrostomic access and urological cystoscopic approach to realign and catheterize the ureteral stumps. In patients with Bricker urinary diversion, peri-anastomotic leaks were treated by positioning a multi-hole pig-tail catheter with the inner end in the renal pelvis and the distal portion outgoing from the cutaneous stoma. Subsequent pyelographic controls demonstrated the resolution of the ureteral leak in all patients and none required a surgical re-intervention. Nephrostomies were removed and ureteral stents were regularly changed. We conclude that interventional uro-radiology may offer a valid conservative option in iatrogenic urinary injuries. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses.Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting).Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter.Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures. [ABSTRACT FROM AUTHOR]

Objective: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. Methods: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. Results: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. Conclusion: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option. [ABSTRACT FROM AUTHOR]

The Seldinger approach to percutaneous nephrostomy and ureteral stent placement involves needle-puncture, guide wire introduction, tract dilation and catheter placement as in angiography. We have used this approach on 101 obstructed renal units without significant complication. Techniques are described in detail with special attention given to those for negotiating tortuous ureters. A guide wire through the kidney to the bladder can be used to place an indwelling stent either from above or below in order to free the patient completely from external appliances. These techniques afford exciting new alternatives in the management of common urological problems. Most of all, they offer nonoperative palliation to terminal cancer patients and suitable alternatives to patients too ill to undergo surgery. [ABSTRACT FROM AUTHOR]