A functional vesicostomy for six decades: A case report

Pituitary gland adenoma with hyperprolactinemia and male erectile dysfunction – A case report

Quiz Page November 2013: An Unusual Cause of Nephrotic Syndrome

O07 Managing relapsing and refractory lupus nephritis in juvenile systemic lupus erythematosus: a case report

RETROPERITONEOSCOPIC NEPHROURETERECTOMY FOR RENAL PELVIC TUMORS WITH A SINGLE ILIAC INCISION

Placenta previa percreta with urinary bladder invasion is a rare but a potentially lethal condition. It is one of the leading causes of intractable postpartum haemorrhage requiring obstetric hysterectomy. The incidence of placenta percreta has dramatically increased due to increase in caesarean section rate. It is associated with increased morbidity and mortality both in mother and fetus. Hence, we present a case report on placenta previa percreta involving bladder who underwent uterine artery embolisation followed by obstetric hysterectomy.

INTRODUÇÃO: Cistite glandular é um processo proliferativo benigno e infrequente da mucosa vesical, caracterizado por proliferação do epitélio e, em alguns casos, formação de glândulas intestinais. Alterações metaplásicas na cistite glandular são bem documentadas na literatura, embora sua etiologia não seja totalmente esclarecida. RELATO DO CASO: Relatamos um caso de cistite glandular em um paciente de 55 anos, apresentando sintomas miccionais irritativos e obstrutivos persistentes sem resposta à terapia com alfabloqueadores. Ultrassonografia evidenciou lesão vegetante no trígono vesical e o paciente foi submetido à ressecção endoscópica por duas vezes e evoluiu com ureterohidronefrose bilateral. Dado o extenso acometimento vesical e a persistência dos sintomas, o paciente foi submetido a cistoprostatectomia e neobexiga ileal com boa evolução pós-operatória. DISCUSSÃO: Há duas formas de cistite glandular: típica e intestinal. A forma típica é a mais comum e a intestinal é marcada pela produção de mucina, mais frequentemente associada ao adenocarcinoma de bexiga. A maioria dos casos de cistite glandular é assintomática, sendo que os pacientes sintomáticos normalmente apresentam hematúria, sintomas urinários irritativos e típicos de cistite crônica. Há controvérsias sobre o tratamento precoce agressivo, sendo que vários estudos propõem a ressecção transuretral e o acompanhamento com biópsias.

Nowadays, ultrasounds allow to discover accidentally a large number of renal small tumors. So, radical nephrectomy, which years ago was considered as the gold standard, is rarely required. Today, nephron sparing surgery is often prescribed for renal masses smaller than 4 cm. Its most frequent complication is calyceal fistula. It can be prevented exploring carefully the surgical surface, and suturing any opening. It can heal over within a few days or some weeks, so it can be a trouble for both the patient and the surgeon. A complete urinary drainage, obtained with an ureteral stent and an open bladder catheter, helps heal. Recently, it has become common practice to spread synthetic or biological tissue sealants over the surgical surface, to improve hemostasis. These surgical glues have also been used to repair calyceal openings, with conflicting results. We performed left renal tumor excision (3.5 x 3 cm) in a 72-years-old man, during temporary renal artery occlusion with surface hypothermia. We placed intraoperatively an ureteral stent. The visual examination of the surgical cavity did not reveal any calyceal opening. We electrocauterized it and stuffed it with FloSeal. Surgical edges were free from illness. After 5 days urinary leakage from the drainage tube increased. Pyelography showed a calyceal fistula. A further stent was placed, with no results. Bladder catheter was kept open for about 2 months. Urinary leakage stopped 34 days after surgery. Urinary leakage increased when the catheter was removed, and stopped only after many days of complete urinary drainage. The conservative treatment of a calyceal fistula must be considered a still effective therapy, also in difficult cases, provided that a complete and long-lasting urinary drainage is carried out.

Objective To study the clinical,histopathological,immunohistochemical features and the diagnosis and treatment of paraganglioma of urinary bladder. Methods Two cases of paraganglioma of urinary bladder were treated. The first case was a male with painless haematuria. The abdominal ultrasonography and CT scan showed a 2.5 cm× 2.0 cm mass in the right anterior wall of the bladder, and urine vanillylmandelic acid elevated to 17. 9- 31. 3 μmol/24 h (normal range 10- 35 μmol/24 h). The second case was a female who presented with 8 years history of headache and palpitation after voiding. Abdominal ultrasonography and CT scan showed a 2. 6 cm× 1.5 cm mass in the left wall of the bladder, and her urine vanillylmandelic acid was 35.3-43.3 μmol/24 h. Results One patient underwent transurethral resection (TURBT) and the other underwent partial cystectomy.The two cases were diagnosed as bladder paraganglioma by pathological examination. Immunohistochemically, the tumor cells were positive for CgA, Syn, NSE and S-100. No evidence of recurrence was detected during follow-up at 3 months and 3 years. Conclusions Paraganglioma of urinary bladder should be considered as a low grade malignancy. Partial cystectomy should be recommended. The diagnosis depends on clinical symptoms, pathological and immunohistochemical results. Key words: Urinary bladder neoplasms; Paraganglioma; Pathology, clinical

Urinary complications following renal transplantation are rather uncommon, but can cause severe problems such as deterioration in renal function, prolonged postoperative morbidity, and loss of the transplanted kidney. Ultrasound and scintigraphy are non-invasive methods used to detect urinary extravasation. Reconstructed CT ureteropyelography has also been employed for the detection of urinary extravasatoin after renal transplantation. MRI imaging can show the renal function of the transplanted kidney and the extravasation. MRI is an effectivde non-invasive alternative for the diagnosis of urinary extravasation after renal transplantation especially when ultrasound and scintigaphy are inconclusive.

or reflux. 3 Because of non-filling of the blind ureter on intravenous urography (IVU), the diagnosis of blind-ending ureteral duplication is best made with the help of retrograde pyelography. However, a blind-ending bifid ureter can be opacified on IVU if uretero-ureteral reflux is present. The anomaly can also be seen on computerized tomography. 4 We report a case featuring a long, blind-ending ureteral duplication complicated by stone formation. Case Report A 45-year old male was admitted with right loin pain, dysuria and frequency of micturition of 3 months duration. He reported passing stones in urine in the past, but had no history of fever or recurrent urinary tract infection (UTI). The patient had presented to another hospital with the same complaints 6 weeks before reporting to our unit. Cystoscopy at that hospital showed a normal bladder with no calculus in the bladder or the ureters. He came to our unit because of persistent pain. Laboratory investigations showed normal renal function. Urine microscopy and culture showed red blood cells in the urine, but no bacterial growth. Plain radiograph of the kidneys, ureters and bladder (KUB) revealed two radio-opaque shadows in the region of the lower third of the right ureter (Figure 1). However, IVU showed patent ureters with no calculus seen in either ureter (Figure 2). A pre-operative CT scan showed grossly normal kidneys and ureters with 2 extravesical masses in the pelvis. Cystoscopy in our unit revealed an edematous mass just caudal and medial to the right ureteric orifice. A guide wire introduced into the right ureter under fluoroscopic control showed that the radio-opaque shadows seen on KUB were extraureteral and extravesical. Right retrograde pyelography showed a patent ureter with opacification of a normal pelvicalyceal system. Transurethral resection of the bullous, edematous mass revealed another ureteric orifice. Retrograde pyelography through the other ureteric orifice revealed multiple filling defects and a long blind-ending ureter, with no opacification of the pelvi-calyceal system (Figure 3). Ureteroscopy through the second ureteric orifice confirmed the presence of 2 calculi, which were removed using a Dormia basket. Post-operatively the patient became pain free. Postoperative micturating cystourethrogram (MCUG) performed 3 months after calculus extraction from the duplicated ureter, showed no vesicoureteric reflux (VUR).

Introdution. Distal Ureteral Stump is a residual ureter after total or partial nephrectomy. It is a rare complication and it also appears many years after surgery. Majority of patients are asymptomatic but Literature reports patients with recurrent bacteriuria or haematuria, empyema, stones and tumors (transitional-cell carcinoma or renal-cell carcinoma). We present one case of diseased ureteral stump and surgical strategy. Case Report. We report a case of a patient subjected to retroperitoneoscopic total nephrectomy when he was seven months old for sympthomatic right vesico-ureteral reflux of IV grade and associated renal hypoplasia. These patient presented recurrent urinary infections after 3 years from the surgery and for this reason we performed voiding micturating cystourethrography who revealed the presence of urinary reflux in the DUS. Because of this surgical removal of stump was necessary and during 2 months follow-up was normal and there weren’t surgical complications or UTI. Discussion. Distal Ureteral Stump is a rare complication but possible after nephrectomy and it is due to partial excision of ureter in the distal portion. Recurrent urinary infections are a usefull signal to subspect the presence of DUS and they are due to persistent reflux of urine and dysfunctional voiding (reservoir) resulting in stasis and infections. Therefore in all patients subjected to total or partial nephrectomy with recurrent urinary infections also after years, the pres- ence of DUS should always be suspected and radiological investigation must be performed for accurate management.

IntroductionLithium has been used for the management of psychiatric illnesses over the years and it continues to be the first-line mood stabilizer used in treatment and prevention of bipolar disorder. Due to its narrow therapeutic index, other prescribed medications can increase lithium levels and potentiate its toxic effects. Among the most described drugs, non-steroid anti-inflammatory drugs and diuretics (mainly thiazides and loop diuretics) are the most commonly implicated. Risk factors for developing lithium toxicity include old age, polypharmacy, renal impairment, hyponatremic and hypovolemic conditions. Although there is interindividual susceptibility, older patients are at particularly higher risk.ObjectivesTo summarize the latest literature about this field and to present a case report as a basis for discussion.MethodsA brief review of the latest literature was performed, using PubMed and the keywords “lithium” and “acute renal injury”. Also, a case report about a 73 year-old man who suffer from lithium intoxication due to lithium-furosemide interaction is presented.ResultsIn the presented case, Mr. F, 73 years old, independent for activities of daily living, was admitted to the Internal Medicine ward due to acute renal injury and lithium intoxication. Initially he was non-collaborative, sleepy, disoriented in all references and speechless. The creatinine was 1.28 mg/dL, urea 63 mg/dL, unspecific leucocitosis 17000/mm3, C-Reactive Protein 8 mg/dL, lithium 2.22 mEq/L. The psychiatrist was called to approach the psychiatric status, but as the patient awareness was impaired, the mental state examination was not possible. The patient’s daughter was interviewed. The patient had bipolar disorder (BD) type 1 and was diagnosed with mild cognitive impairment (MCI) a year ago. He had been stable for BD and MCI until the last month. He began to present nocturia, so he went to a urologist who prescribed him furosemide 40 mg daily for benign prostatic hyperplasia (BPH). Since that moment, he started being confused and progressively went to the state that was previously described at the admission of internment. Furosemide, quetiapine and lithium were stopped. He got better, to his previous state, and then started quetiapine 200 mg/day and tansulosine 0.4 mg/day.ConclusionsInitiating diuretics in patients under lithium should be carefully considered and lithium blood levels must be monitored more regularly when new drugs are prescribed. Other medications must be regarded as alternatives but, if it is not possible, they should be used in the lowest dose and shortest duration as possible. With this case report, we highlight the importance of considering patients as a whole, taking both their physical and mental well-being into account. Healthcare professionals are invited to coordinate their efforts to deliver the best standard of care.Disclosure of InterestNone Declared

Recurrent transitional cell carcinoma in a child with the Costello syndrome.

A case of sarcomatoid carcinoma of the urinary bladder is reported. An 81-year-old man with sarcomatoid carcinoma underwent radical cistectomy was alive without recurrence after six months. The characteristics of the neoplasm are reported and discussed. J Med Cases. 2014;5(2):116-119 doi: http://dx.doi.org/10.14740/jmc1657w

Acute myocardial infarction with preceding infection has been reported before but the exacl mechanism is not clear. We described a case who demonstrated an example how infection may relate to myocardial infarction. A young female suffered from acute myocardial infarction with concomitant urinary tract infection. Transient total occlusion of left anterior descending artery with spontaneous recanalization occurred during coronary angiography. It was supposed due to transient thrombosis or spasm. Clinical recovery was good and patient lived uneventfully thereafter.