Calculus pyelonephritis associated with ureterocutaneostomy.
Takahiro Matsuo1, Nobuyoshi Mori1, Aki Sakurai1
1Department of Infectious Diseases, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo, 104-8560, Japan.
Idcases
|November 14, 2019
Summary
Urinary diversion patients face high risks of kidney stones and infection. Prompt diagnosis and treatment of ureteral calculi in ureterocutaneous fistulas are crucial to prevent life-threatening sepsis.
Area of Science:
- Urology
- Infectious Diseases
- Nephrology
Background:
- Patients with urinary diversions, such as ureterocutaneostomy, are at increased risk for urolithiasis.
- Urolithiasis in these patients can lead to severe complications including sepsis, pyelonephritis, and renal insufficiency.
Purpose of the Study:
- To report a case of ureteral calculus in a ureterocutaneous fistula presenting with sepsis.
- To highlight the importance of early diagnosis and intervention in managing urolithiasis in patients with urinary diversions.
Main Methods:
- A 79-year-old female patient with a history of ureterocutaneostomy presented with fever and a palpable mass.
- Computed tomography (CT) scan identified a ureteral calculus within the ureterocutaneous fistula, causing bilateral hydronephrosis.
- Transureteral stent insertion was performed, and the patient was treated with ampicillin/sulbactam.
Main Results:
- Blood and urine cultures revealed polymicrobial infections, including methicillin-sensitive Staphylococcus aureus (MSSA), Escherichia coli, and Enterococcus faecalis.
- The patient's clinical condition improved significantly with appropriate antimicrobial therapy and urological intervention.
Conclusions:
- Urolithiasis in the setting of urinary diversions poses a significant risk and requires prompt recognition and management.
- Empirical broad-spectrum antibiotic treatment is recommended pending culture results due to the high likelihood of polymicrobial colonization.
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