Background

Emphysematous pyelonephritis is a severe infection of the kidney associated with formation of gas in the renal parenchyma and/or collecting system. The purpose of this study was to evaluate outcomes of patients with emphysematous pyelonephritis in a contemporary cohort and to evaluate the impact of urolithiasis on disease severity.

Methods

A search of all imaging reports at University of California San Francisco (UCSF) for the term "emphysematous pyelonephritis" was undertaken from 2003-2014. Patients were included if there was clinical evidence of infection, no recent urologic instrumentation, and computerized tomography (CT) demonstrating gas in the renal parenchyma or collecting system. Clinical and laboratory variables were obtained from medical records.

Results

A total of 14 cases were identified. The majority of patients (57%) had gas confined to the collecting system. Three patients (21%) had gas in the renal parenchyma and 3 patients (21%) had gas extending into perirenal tissues. A total of 8 patients (57%) had concomitant urolithiasis. Seven patients (50%) were managed with antibiotic therapy alone while 6 patients (43%) required percutaneous drainage. No patients required immediate nephrectomy. There were no deaths. Patients with urolithiasis had less severe emphysematous pyelonephritis than patients without urolithiasis (P<0.05).

Conclusions

The majority of patients in this study had gas contained within the collecting system and were treated successfully with antibiotics alone. Percutaneous drainage was successfully utilized in patients with more advanced disease. No patients required emergent nephrectomy. Emphysematous pyelonephritis in patients with urolithiasis was less severe than in patients without urolithiasis.

We present a case of a patient with xanthogranulomatous pyelonephritis (XGP) presenting with a large (18 × 12 cm) left-sided flank mass with worsening left flank pain. CT abdomen/pelvis demonstrated a left kidney with parenchyma replaced by multiple large hypodense collections containing fluid and gas, a left staghorn calculus, and a communication between the kidney and large flank collection. About 4.5 weeks after initial presentation, the patient underwent operative intervention. Pathology revealed an end-stage kidney with scar consistent with xanthogranulomatous pyelonephritis.

Purpose

Several surgical techniques are available to treat anterior urethral stricture. The choice of surgical technique largely depends on the severity of stricture disease. The U-score (urethral stricture score) is based on urethral stricture characteristics, namely length (1 to 3 points), number (1 or 2 points), location (1 or 2 points) and etiology (1 or 2 points), which are tallied to provide a total score of 4 to 9 points. Our aim was to identify whether the U-score system is predictive of the surgical complexity and outcome of anterior urethroplasty.

Materials and methods

We retrospectively reviewed the records of all patients who underwent anterior urethroplasty from 2002 to 2012 by examining our prospectively collected urethroplasty database. We calculated the U-score and looked for an association with surgical complexity, recurrent stricture and time to recurrence. We defined recurrent stricture as the need for a secondary procedure.

Results

There were 341 patients who underwent low complexity urethroplasty (anastomotic, buccal mucosal graft and augmented anterior urethroplasty) with a mean U-score of 4.7 while 48 underwent high complexity urethroplasty (double buccal mucosal graft, flap and graft/flap combination) with a mean score of 6.9. Higher U-score was predictive of higher surgical complexity (p <0.001). U-score was also significantly associated with recurrence. There was a consistent increase in the risk of recurrence with each additional U-score point. However, there was no association of U-score with time to recurrence.

Conclusions

We confirmed the validity of U-score to predict the complexity of surgery for anterior urethral strictures. For the first time to our knowledge we report an association between higher U-score and anterior urethroplasty outcome. The U-score could be used to risk stratify patients and help with perioperative counseling.

Introduction

Across all specialties, economic pressure is driving increased utilization of outpatient surgery when feasible.

Aims

Our aims were to analyze national trends of penile prosthesis (PP) surgery and to examine patient and hospital characteristics, and perioperative complications in the inpatient setting.

Methods

We analyzed data from National Inpatient Sample. Patients in NIS who underwent PP insertion between 2000 and 2010 were included.

Main outcome measures

Our main outcomes were the number of inpatient PP procedures, type of prosthesis, patient demographics, comorbidities, hospital characteristics, and immediate perioperative complications.

Results

There was a progressive and dramatic decline by nearly half in the number of both inflatable (IPP) and noninflatable (NIPP) inpatient insertions performed from 2000 to 2010 (P = 0.0001). The overall rate of inpatient complications for PP insertion was 13.5%. Patients with three or more comorbidities were found to have a higher risk of complications than patients with no comorbidities (OR = 1.45, 95% CI = 1.18-1.78) (P = 0.0001). Surgeries performed in high-volume hospitals (10 or more PP cases per year) were associated with reduced risk of complications (OR = 0.6) (P < 0.0001). There was a dramatic decrease in inpatient setting for PP placement in high-volume hospitals (32% in 2000 compared with 6% in 2010; P < 0.0001), and when compared with lower volume hospitals. NIPP was more likely performed in younger patients and in community hospitals, and less likely in white patients. Medicaid health insurance was associated with much higher rate of NIPP insertion than other types of insurance.

Conclusions

The number of PP procedures performed in the inpatient setting declined between 2000 and 2010, likely reflecting a shift toward increasing outpatient procedures. Our data also suggest a better outcome for patients having the procedure done at a high-volume center in terms of inpatient complications. Alwaal A, Harris CR, Hussein AA, Sanford TH, McCulloch CE, Shindel AW, and Breyer BN. The decline of inpatient penile prosthesis over the 10-year period, 2000-2010. Sex Med 2015;3:280-286.