Seker KG. et al., 2020: An Unexpected Complication After Extracorporeal Shock Wave Lithotripsy: Emphysematous Pyelitis
Seker KG, Arikan Y, Cetin Seker Y, Ozlu DN, Evren I.
Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR.
Emergency Medicine, Muş State Hospital, Muş, TUR.
Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, İstanbul, TUR.
Emphysematous urinary tract infections (UTI) are life-threatening conditions caused by gas-forming organisms. Emphysematous pyelitis (EP) is a rare, acute bacterial UTI characterized by gas formation only in the renal collecting system. Extracorporeal shock wave lithotripsy (ESWL) treatment was performed for 10-mm sized stone in the left renal pelvis in an 81-year-old female patient with no known comorbidities other than hypertension. In the 10th hour following ESWL treatment, the patient referred to the emergency department with fever and left flank pain. Gas was noticed in the left renal collecting system in non-contrast computed tomography (NCCT). A wide spectrum antibiotic was given to the patient due to EP diagnosis and a nephrostomy catheter was placed in the left renal pelvis. EP should be considered in the patient with fever and flank pain after ESWL and NCCT should be performed for further examination. Quick diagnosis, examination and treatment of these patients in the emergency department are important.
Cureus. 2020 May 27;12(5):e8307. doi: 10.7759/cureus.8307. PMID: 3260729. FREE ARTICLE
The authors describe a case of emphysematous pyelitis after SWL. It is mentioned that the patient had sterile urine test before SWL and that there was no suspicion of bacteriuria.
There is one observation that might be important and that is the low stone density (HU =440). This finding might indicate two major possibilities: either a uric acid stone or an infection stone.
The lesson learnt is that when the stone might be of infection origin it will be of value to insert a stent before SWL with the aim of minimizing the risk for obstruction. This step is particularly important for old and brittle patients in whom obstruction of infected urrine might be particularly dangerous and deleterious.
Whether a single shot of antibiotics should be given only because of a vague suspicion that the patient might have an infection stone is an open question.
One basic point in the current case is that the stone was poorly disintegrated and that the serious course of the disease was explained by obstruction together with release of bacteria from the stone.