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Bibi M, Chaker K, Ouanes Y, Baccouch R, Madani MA, Mediouni H, Mosbahi B, Mourad Dali K, Rahoui M, Nouira Y. Comparison of prognosis of five scoring systems in emphysematous pyelonephritis patients requiring intensive care. Int Urol Nephrol 2023; 55:3045-3050. [PMID: 37556105 PMCID: PMC10611593 DOI: 10.1007/s11255-023-03733-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Our study aimed to evaluate the performance of Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Systemic Inflammatory Response Syndrome (SIRS), and Global Research in the Emphysematous Pyelonephritis group (GREMP) in predicting the need of admission in intensive care units (ICU) for emphysematous pyelonephritis (EPN) patient. PATIENTS AND METHODS In this retrospective study, we reviewed 70 patients admitted to our department from January 2008 to October 2022. Data on clinical presentation and EPN management were noted. The five scoring systems were calculated by one investigator. Univariate and multivariate analyses were used to assess predictive factors of severe sepsis and mortality. Statistical analysis was made using SPSS version 22. RESULTS Mean age was 61.83 years with 65.7% diabetes. As per Huang and Tseng classification, 41 patients had class I EPN, 7 had class II EPN, 8 had class IIIa, 6 class IIIB EPN, and 8 had class IV EPN. Seventeen patients (24.28%) were admitted to ICU with an 18.57 mortality rate. Univariate analysis showed that ICU admission was significantly associated with higher respiration rate and heart rate, lower systolic blood pressure, confusion, CRP, lactate and creatinine serum (p = 0.0001, p = 0.0001, p = 0.001, p = 0.007, p = 0.004, p = 0.001, p = 0.001, respectively). All five scores and Huang and Tseng classification were significantly predictive of admission to ICU. All five scores showed good results under the area curves to predict ICU entry with 0.915, 0.895, 0.968, 0.887, and 0.846 for qSOFA, MEWS score, NEWS score, SIRS, and GREMP score, respectively. CONCLUSION NEWS score seemed to be the best performing physiologic score among the five scoring systems studied and may help with biological and radiological findings to quickly identify EPN patients that need intensive care unit.
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Affiliation(s)
- Mokhtar Bibi
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia.
| | - Kays Chaker
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia
| | - Yassine Ouanes
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia
| | - Ramla Baccouch
- Department of Emergency, La Rabta Hospital, Tunis, Tunisia
| | | | | | | | | | - Moez Rahoui
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia
| | - Yassine Nouira
- Department of Urology, La Rabta Hospital, 1006, Tunis, Tunisia
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Chaker K, Ouanes Y, Chedly WB, Bibi M, Mosbahi B, Fakhfakh H, Abed WE, Hriz A, Rahoui M, Dali KM, Ammous A, Nouira Y. [Outcomes of early endoscopic realignment of post-traumatic posterior urethral ruptures]. Prog Urol 2023; 33:469-473. [PMID: 37634959 DOI: 10.1016/j.purol.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/16/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury. PATIENTS AND METHODS We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up. RESULTS Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23 patients (88.46%). The median time to endoscopic realignment was 8 days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25). CONCLUSION Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Kays Chaker
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie.
| | - Yassine Ouanes
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | - Wassim Ben Chedly
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | - Mokhtar Bibi
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | - Boutheina Mosbahi
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Hend Fakhfakh
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Wiem El Abed
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Aziz Hriz
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Moez Rahoui
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | | | - Adel Ammous
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Yassine Nouira
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
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Chaker K, Ouanes Y, Mosbahi B, Trigui M, Fakhfakh H, Nouira Y. A case of pheochromocytoma in pregnancy: A syndromic association. Int J Surg Case Rep 2023; 106:108291. [PMID: 37148720 DOI: 10.1016/j.ijscr.2023.108291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms. Concurrent pheochromocytoma in pregnant women can lead to severe complications and death due to associated catecholamine excess. CASE PRESENTATION A 37-year-old pregnant woman, without medical or surgical history, gravida 1 para 0, was diagnosed with pheochromocytoma through biochemical and imaging tests at 20 weeks of gestation. Perioperative management included a multidisciplinary approach, symptom stabilization with medical treatment. An open right adrenalectomy was than performed at 23 weeks of gestation. DISCUSSION Pheochromocytoma is a rare but important cause of hypertension in pregnancy. It should be included and investigated as a differential diagnosis in cases of labile hypertension in pregnant women with or without associated symptoms. CONCLUSION A correct diagnosis in all pregnant women with severe hypertension and a multidisciplinary management are mandatory to obtain optimal results and avoid deleterious effects at delivery.
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Affiliation(s)
- Kays Chaker
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia.
| | - Yassine Ouanes
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Boutheina Mosbahi
- Department of Anesthesia, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Trigui
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Hend Fakhfakh
- Department of Anesthesia, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Yassine Nouira
- Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
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Chaker K, Ouanes Y, Azouz E, Trigui M, Madani A, Mosbahi B, Elabed W, Chbeb O, Bibi M, Dali KM, Ammous A, Nouira Y. Acute obstructive pyelonephritis due to pyosalpinx: a case report. J Med Case Rep 2023; 17:166. [PMID: 37095582 PMCID: PMC10127100 DOI: 10.1186/s13256-023-03900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND A pyosalpinx is the acute inflammation of the fallopian tube, which fills up and swells with pus. It commonly results from inadequate or delayed treatment of pelvic inflammatory disease. CASE PRESENTATION We report the case of a 54-year-old Africain female patient, who presented with sustained high-grade fever, right flank pain, and severe acute storage low-urinary-tract symptoms. Computed tomography showed signs of acute obstructive pyelonephritis with a right tubular juxtauterine mass with complex internal fluid and thick enhancing walls exerting a mass effect on the right ureter. A drainage of the right excretory cavities by a JJ stent was performed. An ultrasound-guided aspiration of the collection was also performed. CONCLUSION A pyosalpinx can then exert a mass effect on the excretory cavities, thus causing an acute obstructive pyelonephritis. A double drainage coupled with an effective antibiotic therapy is then necessary.
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Affiliation(s)
- Kays Chaker
- Department of Urology, La Rabta Hospital, University of TUNIS El Manar, Tunis, Tunisia.
| | - Yassine Ouanes
- Department of Urology, La Rabta Hospital, University of TUNIS El Manar, Tunis, Tunisia
| | - Eya Azouz
- Department of Radiology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Trigui
- Department of Urology, La Rabta Hospital, University of TUNIS El Manar, Tunis, Tunisia
| | - Anouar Madani
- Department of Urology, La Rabta Hospital, University of TUNIS El Manar, Tunis, Tunisia
| | - Boutheina Mosbahi
- Department of Anesthesia, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Wiem Elabed
- Department of Anesthesia, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Oumayma Chbeb
- Department of Anesthesia, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Mokhtar Bibi
- Department of Urology, La Rabta Hospital, University of TUNIS El Manar, Tunis, Tunisia
| | - Kheireddine Mrad Dali
- Department of Urology, La Rabta Hospital, University of TUNIS El Manar, Tunis, Tunisia
| | - Adel Ammous
- Department of Anesthesia, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Yassine Nouira
- Department of Urology, La Rabta Hospital, University of TUNIS El Manar, Tunis, Tunisia
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Chaker K, Ouanes Y, Ben Chedly W, Bibi M, Rahoui M, Mosbahi B, Harouni N, Cherif R, Mrad Dali K, Abid K, Sellami A, Ammous A, Nouira Y. Outcomes of early endoscopic realignment for pelvic fracture urethral injury. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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