Gas-forming infections in genitourinary tract.

Diabetes mellitus associated with urinary tract infections and ureteral obstruction can be predisposing factors leading to emphysematous pyelonephritis. Fever, flank pains, and a palpable renal mass, associated with dehydration and hyperglycemia, were the most frequent presenting symptoms associated with emphysematous pyelonephritis. Computerized tomography (CT) scan is the best method to identify a renal or perirenal abscess and its ramifications.

Miliary tuberculosis due to intravesical bacillus Calmette-Guerin therapy.

While receiving treatment for bladder carcinoma with intravesical BCG, a 78-year-old man developed a clinical illness and roentgenographic manifestation of miliary tuberculosis. The transbronchial lung biopsy demonstrated granulomas with giant cells. Treatment with antituberculosis therapy resulted in complete resolution of the illness.

An extrapleural approach with rib removal for the eleventh rib flank incision.

The transcostal extrapleural flank approach to the kidney requires an understanding of the anatomy of the thoracic and abdominal wall to prevent injury to the pleura and subsequent pneumothorax. Isolation of the intercostal neurovascular bundle, division of the lumbodorsal fascia inferior to the rib bed, and simultaneous dissection of the diaphragmatic insertion along the superior and posterior aspect of the twelfth rib toward the lumbocostal arch are necessary surgical maneuvers. This should be done prior to the release of the diaphragm, exposure of Gerota's fascia and positioning of a flank retractor.

The eleventh rib transcostal incision: technique for an extrapleural approach.

The transcostal extrapleural flank approach to the kidney requires an understanding of thoracic and abdominal wall anatomy to prevent injury to the pleura and subsequent pneumothorax. Isolation of the intercostal neurovascular bundle, division of the lumbodorsal fascia inferior to the rib bed and simultaneous dissection of the diaphragmatic insertion along the superior and posterior aspects of the 12th rib toward the lumbocostal arch are necessary surgical maneuvers before release of the diaphragm, exposure of Gerota's fascia and positioning of a flank retractor. Pneumothorax usually results from attempts to separate the pleura from the diaphragm, dissection within the intercostal space rather than along the diaphragmatic insertions and failure to release the diaphragm fully as far as the lumbocostal arch before placement of the retractor.