Complete intraperitoneal displacement of a double J stent: a first case.

OBJECTIVES: Ureteral double-J stents are known to migrate proximally and distally within the urinary tract, while perforation and stent displacement are uncommon. Possible mechanisms of displacement are either original malpositioning with ureteral perforation or subsequent fistula and erosion of the excretory system, due to infection or long permanence of the device. We present the unique case of complete intraperitoneal stent migration in a 59-year-old caucasian male without evidence of urinary fistula at the moment of diagnosis, so far an unreported complication. MATERIALS AND METHODS: Eight months after the placement of a double-J stent for lower right ureteral stricture at a district hospital, the patient came at our observation for urosepsis and hydro-uretero-nephrosis. A CT scan demonstrated intraperitoneal migration of the stent outside the urinary tract. Cystoscopy failed to visualize the lower extremity of the stent, a percutaneous nephrostomy was placed to drain the urinary system and the stent was removed through a small abdominal incision on the right lower quadrant. RESULTS: In our case we presume that during the positioning manoeuvre the guide wire perforated simultaneously the lower ureteral wall and the pelvic peritoneum, and that once the upper end of the stent was coiled, the lower extremity was also attracted intraperitoneally. The lack of pain due to the spinal lesion concurred to this unusual complication. CONCLUSIONS: We must be aware that ureteral double J stents may be found displaced even inside the peritoneal cavity, and that the use of retrograde pyelography during placement is of paramount importance to exclude misplacement of an apparently normally coiled upper extremity of the stent

Candida Bezoars with Urinary Tract Obstruction in Two Women without Immunocompromising Conditions

More than half of the cases of fungal infections of the urinary tract are caused by Candida sp., but occurrence of obstructive uropathy caused by mycetomas or fungus balls (urobezoars) is extremely rare. The latter are conglomerates of fungal hyphae. Diabetes mellitus, immunosuppression, chronic disease, and malignancies are known predisposing factors. Preoperative imaging is not pathognomonic; blood clots, radiolucent urinary calculi, air bubbles, and inflammatory debris can mimic urobezoars. We report on two otherwise healthy women presenting with urinary tract obstruction caused by candidal mycetomas of the renal pelvis that mimicked matrix lithiasis

Evaluating tourist and leisure flows in planning urban ecological integration

the impact of tourism activities on the environment and the use of the Geographic Information Systems (GIS) in order to reduce negative effects. Tourism is growing in number and the qualitative and quantitive negative effects of the natural and cultural heritage are evident. GIS can contribute to organize the tourist flows in order to better distribute them in time and spac

Re: A randomized controlled trial of topical glyceryl trinitrate before transrectal ultrasonography-guided biopsy of the prostate

No abstract is available for this article

Re: indwelling ureteral stents and sexual health: a prospective multivariate analysis . MC Sighinolfi et al. J.Urol 2007, 178 229-31

We read with interest the article by Sighinolfi et al. who prospectively assessed the impact of indwelling ureteral stents on sexual function using the IIEF-5 and Female SFI. At 45 and 60 days after stent insertion 83% of men reported some grade of sexual dysfunction, and 30% of women reported no sexual activity due to stent related anxiety. In recent years there has been an increasing awareness of the need for validated tools to measure objectively the considerable morbidity associated with ureteral stenting, and to address its influence on daily activities. These tools have remained elusive. In this respect the present study significantly adds to the existing literature. Nevertheless we would like to address some issues that we believe deserve scrutiny. Although the authors recognize the robustness of the USSQ developed by Joshi et al. they failed to use it in their study. The USSQ is a validated self-administered instrument with good evaluative and discriminant properties, which explores stent related morbility in 6 areas. The questionnaire has been adopted in several clinical trials and has recently been validated by our group in Italian in a prospective cohort of 66 patients of box sexes with indwelling stents. In the USSQ sexual function for both sexes is investigated with 3 questions evaluating transient but complete sexual dysfunction , pain during intercourse and overall satisfaction for those subjects with a pre-stent active sex life. The 2 specific questionnaires on sexual dysfunction were chosen by Sighinolfi et al. for a more thorough assessment. However one has to recognize that they have not been formally validated in Italian and thus a bias may have been introduced. Moreover with the IEEF-5 the evaluation of pain during intercourse, commonly reported complaint (64% and 45% of men at 1 and 4 weeks after stent insertion, respectively in our series) remains unexplored. Finally a single multidimensional questionnaire with a separate index score for each domain such as the USSQ, would have allowed an easier and more reliable correlation between sexual dysfunction and all other symptoms. Within the same cohort used for our validation study we perform a multivariate analysis to identify predictors of stent related morbidity, including patient age, gender and BMI and stent length, size and location of distal extremity with respect to the midline has determined on abdominal X-ray. Stent distal loop crossing the midline, which was previously shown to impact symptoms negatively , proved to be an independent predictor of morbidity for all USSQ domains including sexual matters. In particular 82% and 100% of original active male and female patients with this condition, respectively reported impaired sexual function at 1 week, compared to 43%and 80% respectively with the stent not crossing the midline (p<0,01). This easily determinable parameter was not investigated by the authors