Imaging and Intervention in Urinary Tract Infections and Urosepsis PDF
Preview Imaging and Intervention in Urinary Tract Infections and Urosepsis
Massimo Tonolini Editor Imaging and Intervention in Urinary Tract Infections and Urosepsis 123 Imaging and Intervention in Urinary Tract Infections and Urosepsis Massimo Tonolini Editor Imaging and Intervention in Urinary Tract Infections and Urosepsis Editor Massimo Tonolini Department of Radiology Luigi Sacco Hospital Milan, Italy ISBN 978-3-319-68275-4 ISBN 978-3-319-68276-1 (eBook) https://doi.org/10.1007/978-3-319-68276-1 Library of Congress Control Number: 2017963141 © Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Contents Part I Clinicians’ Current Perspectives on Urinary Tract Infections 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Massimo Tonolini 2 Introduction to Urinary Tract Infections: An Overview on Epidemiology, Risk Factors, Microbiology and Treatment Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Maria Diletta Pezzani and Spinello Antinori 3 Uncomplicated and Complicated Urinary Tract Infections in Adults: The Infectious Diseases’s Specialist Perspective . . . 17 Spinello Antinori and Maria Diletta Pezzani 4 Perspective from the Urologist . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Ai Ling Loredana Romanò and Antonio M. Granata 5 Perspective from the Andrologist . . . . . . . . . . . . . . . . . . . . . . . . 41 Antonio Maria Granata and Ai Ling Loredana Romanò 6 Nothing Is Simple in Acute Pyelonephritis: A Pragmatic, Semantic Nephrologist’s View . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Giorgina Barbara Piccoli and Francesca Ragni Part II Imaging of Upper Urinary Tract Infections 7 Ultrasound of Upper Urinary Tract Infections . . . . . . . . . . . . . 57 Emilio Quaia, Antonio G. Gennari, and Maria A. Cova 8 Cross-Sectional Imaging of Acute Pyeloureteritis and Pyonephrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Massimo Tonolini 9 CT Imaging and Differential Diagnosis of Acute Pyelonephritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Adriana Vella and Massimo Tonolini 10 Imaging of Extrarenal Spread, Fistulising and Atypical Pyelonephritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Massimo Tonolini v vi Contents 11 MRI and DW-MRI of Acute Pyelonephritis (APN) . . . . . . . . . . 113 Andrea Veltri, Agostino De Pascale, and Dario Gned 12 Cross-Sectional Imaging of Renal Cyst Infection . . . . . . . . . . . 121 Massimo Tonolini 13 Nuclear Medicine in the Management of Patient with Kidneys Intracystic Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Daniele Penna, Vincenzo Militano, Vincenzo Arena, Angelina Cistaro, and Ettore Pelosi Part III Imaging of Lower Urinary and Male Genital Tract Infections 14 Ultrasound of Lower Urinary Tract Infections . . . . . . . . . . . . . 145 Emilio Quaia, Antonio G. Gennari, and Maria A. Cova 15 Cross-Sectional Imaging of Urinary Bladder, Prostate and Seminal Vesicle Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Massimo Tonolini 16 Cross-Sectional Imaging of Urethral, Penile and Scrotal Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Massimo Tonolini Part IV Miscellaneous Topics 17 Cross-Sectional Imaging of Urosepsis . . . . . . . . . . . . . . . . . . . . . 185 Massimo Tonolini 18 Modern Imaging of Urogenital Tuberculosis . . . . . . . . . . . . . . . 191 Massimo Tonolini 19 Imaging Infections in Transplanted Kidneys . . . . . . . . . . . . . . . 199 Stefano Palmucci, Pietro Valerio Foti, and Massimiliano Veroux 20 Interventional Radiology for Drainage of Urine . . . . . . . . . . . . 207 Anna Maria Ierardi, Salvatore Alessio Angileri, Enrico Maria Fumarola, and Gianpaolo Carrafiello 21 Interventional Radiology in the Treatment of Abscess Collections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Anna Maria Ierardi, Salvatore Alessio Angileri, Enrico Maria Fumarola, Filippo Piacentino, Natalie Lucchina, Domenico Laganà, and Gianpaolo Carrafiello 22 Urinary Tract Infections in Infants and Children . . . . . . . . . . . 231 Marcello Napolitano and Anna Ravelli Part I Clinicians’ Current Perspectives on Urinary Tract Infections 1 Introduction Massimo Tonolini Arguably representing one of the most prevailing (d) Systemic inflammatory response syndrome infectious illnesses worldwide, urinary tract with fever or hypothermia, hyperleucocytosis infections (UTIs) are generally considered trivial or leucopenia, tachycardia and tachypnoea by most physicians, since the majority of cases (e) Circulatory and organ failure [2] encountered in the general population are uncom- plicated occurrences in otherwise healthy young Furthermore, UTIs represent the commonest women. However, UTIs account for hundreds of (almost 40%) form of hospital-acquired infec- thousands of outpatient visits and emergency and tions, with bladder catheterisation as the key risk hospital admissions yearly, resulting in a signifi- factor. The EAU guidelines define complicated cant clinical and economic burden [1–3]. UTIs (C-UTIs) as those associated with struc- Indeed, UTIs encompass a heterogeneous tural or functional abnormalities of the genitouri- spectrum of conditions ranging from asymptom- nary tract, or with the presence of an underlying atic bacteriuria to mild uncomplicated cystitis, disease that interferes with host defence mecha- potentially severe pyelonephritis and life- nisms, that result in an increased risk of acquiring threatening sepsis. Clinical manifestations of infection or failing therapy. The commonest con- UTIs may be limited or overlap with pre-existing ditions predisposing patients to either acquiring complaints from chronic urinary tract dysfunc- infection or experiencing a more severe outcome tion. According to the European Association of are categorized with the mnemonic RENUC and Urology (EAU) guidelines, severity of UTIs summarized in Table 1.1 [2]. should be graded clinically as: Traditionally, the vast majority of ascending UTIs were considered uncomplicated and did not (a) Asymptomatic routinely require imaging investigation, particu- (b) Causing local symptoms such as dysuria, uri- larly in women of childbearing age. During my nary frequency, urgency, supra- or retropubic years as a resident in diagnostic imaging at the pain or bladder tenderness San Paolo Hospital in Milan (Italy) in the late (c) Causing general symptoms including fever, 1990s, radiologists were only occasionally flank pain, nausea and vomiting requested to investigate patients with suspected UTIs, in the vast majority of cases to exclude uri- nary obstruction with ultrasound and occasion- M. Tonolini ally to study sequelae after acute pyelonephritis Radiology Department, “Luigi Sacco” University (APN) with intravenous pyelography. In fact, Hospital, Via G.B. Grassi 74, Milan 20157, Italy until a few years ago, the diagnosis of UTI was e-mail: [email protected] © Springer International Publishing AG 2018 3 M. Tonolini (ed.), Imaging and Intervention in Urinary Tract Infections and Urosepsis, https://doi.org/10.1007/978-3-319-68276-1_1 4 M. Tonolini Table 1.1 Risk factors for acquiring urinary tract infection, developing complications and/or failing treatment (mne- monic RENUC) (Reproduced from Open Access Ref. no.[17], partially adapted from Ref.no. [2]) Type Risk factors Risk of more severe outcome Recurrent Sexual behaviour No Contraceptive devices Postmenopausal hormonal deficiency Controlled diabetes mellitus Extra-urogenital Pregnancy Yes Male gender Badly controlled diabetes Immunosuppression including HIV, uraemia, transplant recipients, on corticosteroids, chemotherapy or immunosuppressants Connective tissue disease Nephropathy Impaired renal function Yes Polycystic kidney Urological Obstructive uropathy, e.g. congenital, Yes lithiasis, stricture, tumour Short-term catheterisation Neurogenic bladder Urological surgery or instrumentation Permanent catheter or non- Long-term catheter Yes resolvable urological risk factors Non-resolvable obstruction Badly controlled neurogenic bladder primarily clinical and based upon a combination tions and on the increasingly concerning issue of of clinical symptoms and signs plus consistent bacterial resistance to antibiotics. urinalysis and biochemical changes. At those Furthermore, growing evidence has accumu- days, imaging was reserved for: lated on the potential detrimental effect of UTI on renal function, which results from a combination (a) Patients with unusually severe symptoms, in of direct cellular injury and indirect effects of which differentiation from renal colic or inflammatory mediators. In patients with pre- other acute abdominal disorders was required existing normal renal anatomy and function, renal (b) Patients with recurrent UTIs, to look for scarring has been reported to develop in up to underlying treatable structural or functional 55% of patients after APN. Patients with chronic abnormalities kidney disease or diabetes are particularly prone (c) Patients with predisposing conditions to to progression of renal infection and deterioration C-UTIs such as diabetes, immunosuppres- of function, with the latter becoming permanent sion, etc. in the majority (77%) of cases [2, 7]. (d) Patients who failed to respond to conven- A highly prevalent disease, APN, reaches an tional antibiotic therapy within 72 h [4–6] annual incidence of 250,000 cases and yearly accounts for over 100,000 hospitalizations in the Meanwhile, during the last decade, the scenario USA, with a non-negligible mean duration of UTI has changed, as discussed in the first sec- (11 days). However, there is no consensus on the tion of this book which includes current clinical definition of APN, which – until a few years ago – perspectives from prominent urologists, nephrolo- was almost invariably diagnosed clinically on the gists and specialists in infectious diseases. In these basis of fever, flank pain and tenderness, signs and chapters emphasis is placed on high-risk popula- symptoms of lower UTI, accompanied by leucocy- 1 Introduction 5 tosis, increased acute phase reactants, haematuria, a consistent basis for correct therapeutic choice. bacteriuria and positive urine culture [2]. Emphasis is placed on the increasingly imple- However, several recent studies-particularly mented diffusion-weighted (DW)-MRI sequences those by G.B. Piccoli and C. Rollino-reported and apparent diffusion coefficient (ADC) maps that APN presents with full-blown features in to differentiate between spared parenchyma, only a minority of patients. The correlation nephritis and abscesses, particularly in children between clinical presentation, entity of abnormal and patients with contraindication to intravenous biochemistry (C-reactive protein and leukocyte contrast [12–16]. count) and extent of renal lesion in APN is often The third section of this volume reviews the very limited: oligosymptomatic manifestations imaging appearances of UTIs involving the pros- may correspond to multifocal lesion or abscesses, tate, seminal vesicles, urethra, perineum, penis which require hospitalization and long-term ther- and scrotum. Despite improved standards of apy, and are associated with higher risk of devel- care, “lower” UTIs are increasingly observed in oping renal scarring. Furthermore urine, blood patients with risk factors such as neurogenic dys- cultures and both are positive only in 23.5–40%, function, bladder outlet obstruction, obstructive 15.8–30% and 7.6% of cases, respectively, uropathy, urologic instrumentation or indwelling mostly because of previous empirical antibiotic stent, urinary tract postsurgical modifications, therapies administered in the outpatient setting chemotherapy or irradiation, renal dysfunction, [8–10]. Conversely, a few other studies showed diabetes and immunodeficiency [3]. With ade- that some early available clinical predictors, quate technique and awareness of consistent find- namely, diabetes, hypotension, high leucocytosis ings, CT and MRI comprehensively assess the and acute renal failure, may identify almost all lower genitourinary structures and disorders and patients with moderate (except for some cases of increasingly provide accurate detection of pres- microabscesses) and severe APN [11]. ence and extent of infectious changes, of pos- Since choosing the most appropriate treatment sible complications, and assist in the differential relies on severity assessment, nowadays there is a diagnosis [17]. growing need for “pathological” diagnosis of Furthermore, in our experience imaging signs APN by radiological demonstration of parenchy- of clinically unsuspected C-UTI may be inci- mal involvement; this is particularly true for dentally detected in imaging studies performed abscessual forms, which require longer intensive to investigate other conditions such as urolithia- in-hospital intravenous antibiotic therapy and are sis, renal colic, gynaecologic pain or unspecific associated with higher risk of developing renal abdominal pain [17]. Cross-sectional imaging is scars [2]. paramount in the triage of sepsis, to confirm an Meanwhile, state-of-the-art multidetector underlying urological cause: albeit less severe computed tomography (CT) and magnetic reso- compared to other sources, urosepsis remains nance imaging (MRI) reached extremely high associated with 20–40% mortality [2, 7]. accuracy in delineating the nature and extent of Other dedicated chapters, respectively, review: APN changes and consistently depict complica- tions such as abscess and obstruction. Emergency – The role of nuclear medicine (specifically physicians increasingly request early imaging of with positron emission tomography) in the suspected APN, which is preferably carried out detection and follow-up of infections in poly- with MRI particularly in young patients and cystic kidneys childbearing age women. Therefore, the fol- – The imaging of urogenital tuberculosis in the lowing ample radiological section of this book current CT era reviews the role, techniques and imaging appear- – The imaging of UTI in patients with renal ances of upper UTIs using ultrasound and con- transplant trast-enhanced ultrasound (CEUS), multidetector – The expanding role and possibilities of inter- CT and MRI to assess severity and thus provide ventional radiology in the treatment of severe
Description:The list of books you might like
