Analysis of the Factors of Therapeutic Failure after Transition to Acriptega: About Two Cases
Published on: 20th February, 2026
Acriptega, a combination of Dolutegravir, Lamivudine, and Tenofovir, is a cornerstone of modern antiretroviral therapy due to its efficacy and tolerability. However, treatment failures persist despite this optimization, raising questions about barriers to successful treatment. Through the analysis of two clinical cases, this study explores the biological and behavioral factors contributing to these failures following a switch to this molecule.The first case is a 69-year-old female patient, diagnosed with HIV in 2002 following pulmonary tuberculosis, who was regularly monitored with an undetectable viral load and a CD4 count > 500 cells/mm³ until the Acriptega transition and the onset of tumor symptoms in 2024. The second case is a 62-year-old female patient, diagnosed with HIV in 2009 following cerebral toxoplasmosis. She was regularly monitored with good treatment adherence and an undetectable viral load. After switching her triple therapy, she developed gastroenteritis, which led to the discovery of her treatment failure. This case study highlights that failure after switching to Acriptega is linked to the absence of prior resistance testing (genotyping). A safe switchover requires a rigorous assessment of the patient’s virological history to prevent the emergence of cross-resistance. Close monitoring via genotyping is essential.
Stone on the Mesh: Intravesical Erosion after Laparoscopic Promontofixation-A Hidden Cost of Durability
Published on: 19th February, 2026
Intravaginal erosion of synthetic mesh after laparoscopic promontofixation(sacrocolpopexy) is an uncommon but clinically relevant late complication. When mesh becomes exposed within the bladder, it may function as a persistent foreign body, encouraging chronic inflammation, bacterial colonization, recurrent lower urinary tract symptoms, and progressive encrustation that can culminate in bladder stone formation. We report a 60-year-old woman with a history of laparoscopic promontofixation using standard polypropylene mesh performed approximately five years earlier. She presented with progressive urinary symptoms. Bladder ultrasound demonstrated an intravesical calculus, and diagnostic cystoscopy confirmed a bladder stone developing on exposed intravesical mesh fibers, consistent with intravesical mesh erosion. Endoscopic management was performed with cystolithotripsy followed by section/resection and removal of the exposed intravesical mesh to eliminate the lithogenic nidus, with a favorable outcome. In women with prior promontofixation presenting with bladder stones, recurrent urinary tract infections, hematuria, or persistent irritative urinary symptoms, intravesical mesh erosion must be considered. Cystoscopy is essential for diagnosis because imaging may identify the stone but not the underlying foreign-body etiology, and definitive treatment requires both stone clearance and elimination of intravesical foreign material to prevent recurrence.
Obstructive Pyelonephritis Due to Postoperative Ureteral Stricture: A Case Report
Published on: 9th February, 2026
Iatrogenic ureteral injury is an uncommon but potentially severe complication of abdominopelvic surgery. When not identified intraoperatively, it may present days to weeks later with flank pain, fever, urinary tract infection, and imaging evidence of obstruction. Early recognition and timely urinary diversion are essential to prevent sepsis and preserve renal function.A 65-year-old patient underwent elective resection of an abdominal mass; pathology confirmed schwannoma. On postoperative day 15, the patient developed left flank pain and fever. Laboratory tests showed leukocytosis (WBC 15,000/mm³) and elevated C-reactive protein (150 mg/L); urine culture grew Escherichia coli. Contrast-enhanced CT demonstrated left hydronephrosis without stones, suggesting postoperative ureteral obstruction. Retrograde double-J stenting was attempted but failed. Urgent percutaneous nephrostomy achieved decompression with clinical improvement under targeted antibiotics. Definitive exploration revealed a 1 cm stricture of the lumbar ureter, managed by segmental resection and tension-free spatulated termino-terminal ureteroureterostomy over an internal stent. Postoperative recovery was uncomplicated; the stent was removed after 3 weeks. Follow-up ultrasound showed no persistent pelvicalyceal dilatation.Delayed ureteral obstruction should be suspected in postoperative patients presenting with flank pain, fever, and hydronephrosis. When retrograde stenting fails in the setting of infection, percutaneous nephrostomy provides rapid decompression and source control, allowing delayed definitive reconstruction. For short-segment proximal or mid-ureter strictures, ureteroureterostomy remains a reliable option when performed according to reconstructive principles.
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