Bladder Masses

Effect of ryanodine on the contractile response of the normal and hypertrophied rabbit urinary bladder to field stimulation.

Malacoplakia is a rare inflammatory condition most often affecting the genitourinary system. We report the case of a 24-year-old man who presented with gross hematuria, nocturia, frequency, dysuria and considerable weight loss during the preceding three months. Digital rectal examination showed a solid pelvic mass. Ultrasonography and computed tomography showed calyceal dilatation on the right side and a solid bladder mass 10 cm in diameter suspicious of bladder cancer. Transurethral resection of the tumor was incomplete, due to the large volume of the bladder mass. Histological examination of the resected specimen revealed malacoplakia of the bladder. The patient was treated with fluoroquinolone and vitamin C. Follow-up at 3 months showed marked regression of the bladder mass and complete resolution of the calyceal dilatation.

MP31-19 ESTROGEN RECEPTOR-ALPHA IS NECESSARY FOR HORMONAL INDUCTION OF PROSTATE GROWTH IN MALE MICE

Hematuria is a common sign of kidney and urinary tract issues in sickle cell disease (SCD). Hematopoietic stem cell transplantation (HSCT) can cure SCD but may also be complicated by conditions that cause hematuria. We report a case of painless hematuria caused by a bladder mass in a young woman after allogeneic HSCT for SCD. Further evaluation showed a friable pseudotumor of the bladder, which was deemed benign based on histological examination. The hematuria resolved with continuous bladder irrigation and cauterization of the bleeding mass. This case highlights that hematuria can originate from hidden pre-existing bladder lesions in the post-transplant setting.

The urinary bladder responds to distension induced by a number of different stresses with rapid and substantial increases in bladder mass and concomitant alterations in the contractile responses to neuronal stimulation, pharmacological simulation by autonomic agonists, and membrane depolarization. Furosemide, sucrose, or diabetes-induced diuresis, as well as outlet obstruction and overdistension all produce similar effects on the bladder. Accompanying the increases in bladder mass and contractile changes are increases in DNA synthesis and [3H]-thymidine uptake. Autoradiographic studies have localized the increased DNA synthesis following bladder distension initially to the urothelium, followed by slower increases in labelling of the lamina propria and extramural connective tissue. The net result of these compartmental differences in DNA synthesis is a reorganization of the structural relationships between smooth-muscle cells, the connective-tissue matrix, and the extrinsic connective-tissue lamina. This may contribute to the functional changes which occur after severe overdistension. Increases in the expression of heat-shock protein-70, basic fibroblast growth factor, N-ras, and c-myc, and decreases in transforming growth factor-beta occurred acutely after obstruction, suggesting that these changes may play a role in obstruction-induced bladder hypertrophy. Removal of the obstruction induces apoptosis of urothelial and connective tissue elements in the bladder, accompanied by increases in transforming growth factor-beta and decreases in basic fibroblast growth factor genes, and a reversal of the bladder dysfunction. Therefore the bladder hyperplasia after outlet obstruction and the regression following removal of the obstruction seem to be directly opposing processes governed by gene expression.

A 79-year-old woman with a history of diabetes mellitus and recurrent urinary tract infections (UTIs) presented with acute onset left lower quadrant pain, left-sided back pain, vomiting, and dysuria. Abdominopelvic CT scan revealed left hydroureteronephrosis to the level of the left ureterovesical junction (UVJ) where a bladder mass appeared to be obstructing the left ureteral orifice. The obstruction was ultimately found to be the result of a sloughed renal papilla lodged in the distal ureter, which created an inflammatory mass at the UVJ. Her history of diabetes and frequent UTIs likely predisposed her to the development of renal papillary necrosis (RPN) that resulted in sloughing of a renal papilla, distal ureteral obstruction with subsequent bladder inflammation that mimicked a bladder mass on imaging. RPN is a condition associated with many etiologies and likely represents a common final pathway of several diseases. Although several hypotheses exist, it is primarily thought to be ischemic in nature and is related to the underlying physiology of the renal papillae. We present a case of hydroureteronephrosis and bladder mass secondary to a sloughed renal papilla from RPN.

Purpose: To describe the clinical-pathological profile of sequelae of urogenital schistosomiasis. Patients and methods: We performed a retrospective study of the sequelae for cases of urogenital schistosomiasis treated between January 2011 and December 2016. These cases were from Senegal and neighboring countries. Results: We included 43 cases. The mean age of the patients was 43.2 ± 16.6 years (14 - 75 years). The sex ratio was 3.3. The sites of the sequelae lesions were the bladder and pelvic ureters in 83.7%, the bladder only in 13.9%, and the ureters only in 2.3% of the patients. Bladder wall calcification was the most common lesion (74.4%), followed by bladder masses (48.8%). Stenosis of the orifice was the most common ureteral lesion (30.2%). The bladder masses were a squamous cell carcinoma in ten cases, a urothelial carcinoma in one case, and a schistosomiasis granuloma in five cases. In one patient, the histological type was not specified. Of the ten cases of squamous cell carcinoma, eight had died of cancer. Of the twelve cases of ureteral orifice stenosis treated by ureterocystoneostomy, the outcome was good in nine cases and poor in three patients. Conclusion: In this study, sequelae of urogenital schistosomiasis were most often observed in young adult males. The most common sequelae were vesical and ureteral calcifications, bladder cancers, and pelvic ureter strictures.

In Vitro Rat Bladder Function After Neonatal Estrogenization

Endometrial cancer, the fourth most common cancer affecting women in the USA, typically recurs locally or can invade regional lymph nodes and the peritoneum. A 66-year-old female with history of Stage 1b endometrial adenocarcinoma was found to have rectal adenocarcinoma on surveillance colonoscopy. Cross-sectional imaging demonstrated a vaginal cuff mass with bladder wall thickening and unilateral hydronephrosis. A bladder mass was identified and partially resected on cystoscopy; pathology was indicative of urothelial carcinoma. The final surgical specimen demonstrated endometrial cancer as the primary culprit in all three organs, confirmed by additional immunohistochemical staining of the previous bladder resection specimen. The rarity of hollow organ involvement in locoregional endometrial cancer recurrence can engender misdiagnosis, potentially leading to discordant treatment and suboptimal outcomes. A high index of suspicion in conjunction with multidisciplinary discussion may have prompted additional immunohistochemical testing to obtain the correct diagnosis earlier in the patient's clinical course.

A 66-year-old female patient was referred to drology department when a bladder mass was incidentally found on a transvaginal ultrasound scan. Cystoscopy revealed a small, smooth mass just above the...

Prolonged obstructed labor is a critical intrapartum emergency. This intricacy is, however, unusual as a primary presentation of a giant bladder calculus. We report a case of a 25-year-old Para 6 + 1, who presented with a history of labor pains of 72 hours duration. She had background lower urinary tract symptoms with supra-pubic swelling and hematuria of 2 years duration. She had a single antenatal visit at 32 weeks however; no obstetric ultrasound scan was done before she went into labor. Examination revealed a highly placed fetal head with increase fetal heart rate. There was a hard mass bulging under the anterior vaginal wall. The diagnosis was a prolonged obstructed labor secondary to bladder mass with fetal distress was made. She had a caesarean section (CS) with the delivery of fresh stillborn. The bi-manually palpable bladder mass persisted post-CS. Her abdominopelvic ultrasound scan and abdominal X-ray post-CS revealed giant vesical calculus with obstructive uropathy. Urine microscopy culture and sensitivity yielded E. coli sensitive to Ciprofloxacin; other laboratory investigations were normal. She was treated for UTI and 2 weeks post-CS, she had opened cystolithotomy. The stone weighed 536 g. Her postoperative recovery was uneventful.

Tadenan (Debat Laboratories, France) is a plant extract used in Europe for the treatment of micturition disorders associated with benign prostatic hypertrophy (BPH). Prior studies demonstrated that pretreatment of rabbits with Tadenan significantly reduced the contractile dysfunction observed after 2 weeks of partial outlet obstruction. The specific aim of the present study was to determine the effect of Tadenan therapy following the creation of partial outlet obstruction. Two sets of experiments were performed: one with mild and the other with severe outlet obstruction. For both sets of experiments, male New Zealand rabbits (3-5 kg) were separated into 3 groups of 5 rabbits each. Each rabbit in groups 1 and 2 was obstructed using standard methodology. Rabbits in group 3 served as controls and did not receive any surgery. After 2 weeks, each rabbit in group 1 received Tadenan orally at 100 mg/kg/day for 3 weeks; each rabbit in group 2 received vehicle (peanut oil). After 3 weeks of treatment (5 weeks after partial outlet obstruction), rabbits were anesthetized and cystometries were performed. Immediately after cystometry, the rabbits were euthanized, the bladder rapidly removed, and 4 longitudinal strips prepared and mounted in individual baths for contractile studies. The contractile responses to field stimulation, carbachol, adenosine-5'-triphosphate (ATP), and potassium chloride (KCl) were determined, as follows: (1) Bladder mass approximately doubled in the mildly obstructed groups. Bladder mass increased significantly (3-5-fold) in the severely obstructed groups. (2) Cystometrograms from the mildly obstructed rabbits treated with peanut oil showed low compliance, whereas those of the mildly obstructed rabbits treated with Tadenan showed normal compliance. The cystometrograms of all severely obstructed rabbits showed low compliance. (3) Mild obstruction caused small but significant decreases in the contractile response to field stimulation that were reversed by Tadenan treatment. No changes were noted in response to bethanechol, ATP, and KCl stimulation. (4) Severe obstruction caused significant decreases in the response of bladder strips to field stimulation and bethanechol. Following Tadenan therapy, there was a significant improvement in the response to high-frequency field stimulation and a substantial improvement in the response to bethanechol (response equal to control). No changes were noted in response to ATP and KCl stimulation. In conclusion, Tadenan treatment reversed the bladder dysfunctions induced by mild partial outlet obstruction, and resulted in improved bladder function in the severe model of outlet obstruction. These studies are consistent with previous studies showing that Tadenan pretreatment protects the bladder against the development of contractile dysfunctions.

Mullerianosis of the urinary bladder

A 32-year-old healthy woman from China was diagnosed with a bladder mass during pelvic ultrasonography, carried out during the work-up of a miscarriage. Cystoscopy by the Department of Obstetrics and Gynecology confirmed the presence of a bladder mass, after which she was referred to our department for evaluation and management. The patient was asymptomatic at presentation. She denied urologic symptoms and did not have a history of smoking or industrial exposure to carcinogens. Laboratory test results and urine studies were unremarkable. Cytology revealed benign cells with numerous micro-organisms. Intravenous pyelography revealed a 1 x 2 cm filling defect in the mid posterior bladder compatible with a mass. There were no upper urinary tract defects. We performed cystoscopy with transurethral resection of the bladder tumor. Pathology revealed cystitis glandularis. The patient was followed up with repeat cystoscopy after 4 months; there was no evidence of recurrence. She was scheduled for surveillance after a further 3 months, but was lost to follow-up.

Introduction: With the advancement in imaging abilities like thin slicing, volume rendering and 3D reconstruction, multidetector CT urography has been a preferred over other imaging modalities for the comprehensive assessment of kidney, ureter and bladder. Hematuria is one of the commonly encountered complaints of patients in hospital. The aim of our study was to evaluate the role of Multidetector computer tomographic urography in hematuria and guiding the clinician to find cause and manage it. Methods: A hospital based prospective cross-sectional study conducted among 228 patients in the duration of one year who presented with either gross or microscopic hematuria and fulfilled the inclusion criteria. Data collected were analyzed using Statistical Package for Social Sciences version 26.0. Results: Patients commonly presented with gross hematuria 148(64.9%). Most common cause of hematuria as per our study was urolithiasis, 103 patients. Calculus predominantly involved kidney 66(64%) or kidney and ureter 14(13.5%). Hydronephrosis was seen in 87(38.2%) of patients and hydroureter in 37(15.4%) of patients. Normal excretion was observed in 202(88.6%) patients whereas delayed excretion and non-excretion was seen in 13(5.7%). Infection/inflammatory conditions occurred in 34(14.9%) patients, pyelonephritis 17(50%) and cystitis 11(32.3%) being the common occurrences. Most common benign mass occurred in kidney, 65% of all renal masses. Bladder mass was found to be malignant in 80% of the detected bladder masses. Out of five detected adnexal masses, 3(60%) was found to have benign characteristics. Incidental findings included spectrum of diseases and disorders that included anatomical variants, lesions in other sites and congenital defects. Conclusions: With the findings from our study, we can conclude that MDCT Urography is found to be highly accurate in detecting the causes of hematuria and guide in timely management. It is also useful in detection of other underlying conditions with the incidental findings.