[Downloaded free from http://www.urologyannals.com on Monday, November 24, 2014, IP: 41.234.27.97] || Click here to download free Android application for this journal

Letter to Editor The poly-antibiotic anti-bacillary treatment is administered REFERENCES for 6 months, and has to be completed 6 weeks before any 1. Symes JM, Blandy JP. Tuberculous of the male . Br J Urol surgical intervention. This allows preventing reactivation of 1973;54:432-6. latent forms in the scar tissue and dissemination of Koch 2. Chambers RM. Tuberculous urethral fi stula. Br J Urol 1971;43:243-8. [5,6] Bacillus the healthier tissue during surgery. The treatment 3. Dje AK, Yao AB, D’horpock BF, Tchimou J. Urogenital tuberculosis: has to be similar to that of nonspecific BK forms. Expended Diagnosis diffi culties. Ann Urol 2003;37:233-5. urethroplasty is preferred considering the fibrosis that is often 4. Gupta NP, Kumar R, Mundada OP, Aron M, Hemal AK, Dogra PN, et al. found in urethra and putrefied urethral tissues. Reconstructive surgery for the management of genitourinary tuberculosis: A single center experience. J Urol 2006;175:2150-4. 5. Gupta N, Mandal AK, Singh SK. Tuberculosis of the prostate and urethra: Isolated urethral tuberculosis is very rare even in endemic A review. Indian J Urol 2008;24:388-91. countries. We suggest considering urethral tuberculosis before a 6. Koutlidis N, Fillion A. Urogenital tuberculosis, EMC urologie (Elservier in patients living in endemic areas of tuberculosis. Masson SAS, Paris), 18-078-A-10, 2009.

Ahmed-Amine Bouchikhi, Abdelhak Khallouk, Access this article online Mohammed Jamal El Fassi, Moulay Hassan Farih Quick Response Code: Website: Department of Urology, University Hospital of Fez, Fez, Morocco www.urologyannals.com Address for correspondence: Dr. Ahmed-Amine Bouchikhi, DOI: Rue Zag, Rce Andalous III, Quarier Al-Wafe, Fès, 30070, Marocco. 10.4103/0974-7796.134307 E-mail: [email protected]

and was afebrile. He was catheterized for retention of urine Hemorrhagic cystitis: which drained 1.5 L of blood-tinged urine in urinary bag. A rare manifestation of His investigations, at admission, revealed hemoglobin of 10.1 g%, total leukocyte count of 9,700/mm3, blood sugar organophosphate poisoning of 62 mg%, blood urea of 28 mg%, serum creatinine of 0.8 mg%, and normal serum electrolytes. His liver function test Sir, and coagulation profile were within normal limits. Urinalysis Acute organophosphate poisoning usually presents due to excess by dipstick showed no ketones or proteins. Microscopic of acetylcholine at nerve endings because of inhibition of examination of the urine showed >100 red blood cells (no acetylcholinesterase enzyme. Renal toxicity related to excretion dysmorphism) per high-power field and no evidence of pus of organophosphate through kidneys has been reported. cells, bacteria, or cast. Ultrasonography of the abdomen and Hereby, we are presenting an unusual case of organophosphate pelvis showed normal echotexture of both the kidneys with poisoning where patient presented with hemorrhagic cystitis echogenic material in the urinary bladder consistent with blood after 5 days of ingestion of organophosphate (chlorpyrifos). clots. Contrast-enhanced thin slice computed tomography A 32-year-old gentleman, farmer by occupation, presented of the urinary tract delineated diffuse thickening of urinary to us with of 1 day duration. He reported to have bladder wall and surrounding fat stranding along with thickened accidently ingested chlorpyrifos when he drank water from walls of left lower 1/3rd of suggestive of cystitis and an empty container of insecticide (chlorpyrifos). Within few left . Rhabdomyolysis was also ruled out as a cause hours of intake of water from the container, he complained of blood-tinged urine as levels of creatine kinase, lactate of uneasiness, muscle twitching, diarrhea followed by brief dehydrogenase, and serum glutamic oxaloacetic transaminase period of unconsciousness. He was diagnosed of acute in blood were within normal limits. The patient was diagnosed organophosphate poisoning and managed symptomatically of hemorrhagic cystitis and managed conservatively with at some other hospital and discharged in good condition antibiotics and saline irrigation of urinary bladder. The patient after 2 days. After 5 days of ingestion of chlorpyrifos, he was discharged after 2 weeks in good general condition. presented to our emergency with complaints of hematuria, burning micturition, and retention of urine. At presentation, Chlorpyrifos is one of the most commonly used organophosphate he was conscious, fully alert with pulse rate of 88/min, blood insecticides worldwide. Acute toxicity occurs when exposure pressure of 122/76 mm Hg, respiratory rate of 18/min, occurs through inhalation, dermal, or oral ingestion.[1] It

Urology Annals | Jul - Sep 2014 | Vol 6 | Issue 3 271 [Downloaded free from http://www.urologyannals.com on Monday, November 24, 2014, IP: 41.234.27.97] || Click here to download free Android application for this journal

Letter to Editor acts by phosphorylation of acetylcholinesterase enzyme at Address for correspondence: nerve endings resulting in excess of acetylcholine. Metabolic Dr. Pankaj Kumar Garg, Department of Surgery, Room No. 2207, bioactivation of chlorpyrifos in liver by cytochrome P450 Ward 22, Dilshad Garden, New Delhi, India. enzyme (Cytochrome P450 2B6) is required for its action. E-mail: [email protected] Chlorpyrifos is mainly eliminated from body through kidneys as metabolites (Trichloro-2-pyridinol , diethyl phosphate, and REFERENCES [2] diethyl thiophosphate). Symptoms of acute exposure include 1. Pandit V, Seshadri S, Rao SN, Samarasinghe C, Kumar A, Valsalan R. numbness, tingling, headache, tremors, nausea, vomiting, blurred A case of organophosphate poisoning presenting with seizure and vision, respiratory depression, and bradycardia. At higher doses, unavailable history of parenteral suicide attempt. J Emerg Trauma Shock it may result in loss of consciousness, incontinence, seizures, 2011;4:132-4. 2. CDC. Third National Report on Human Exposure to Environmental and death. Renal toxicity related to organophosphate poisoning Chemicals; U.S. Department of Health and Human Services, Centers for has been reported as rare manifestations. A rare case report of Disease Control and Prevention, Atlanta. 2005. p. 349-77. acute renal failure related to organophosphate poisoning was 3. Albright RK, Kram BW, White RP. Malathion exposure associated with acute reported in which immune complex-related nephropathy was renal failure. JAMA 1983;250:2469. postulated.[3] Another case report of renal toxicity leading to 4. Wedin GP, Pennente CM, Sachdev SS. Renal involvement in organophosphate poisoning. JAMA 1984;252:1408. [4] crystalluria without renal failure was reported. In animal 5. Mikhail TH, Aggour N, Awadallah R, Boulos MN, El-Dessoukey EA, studies, chlorpyrifos has been related to cloudy swelling Karima AI. Acute toxicity of organophosphorus and organochlorine of convoluted tubules.[5] This case is highlighted to report insecticides in laboratory animals. Z Ernahrungswiss 1979;18:258-68. an unusual presentation of hemorrhagic cystitis related to chlorpyrifos poisoning which was probably related to direct Access this article online toxicity of its metabolites excreted through kidneys. Quick Response Code: Website: www.urologyannals.com Manish Jain, Dekid Palmo, Vivek Agrawal, Pankaj Kumar Garg DOI: Department of Surgery, University College of Medical Sciences and 10.4103/0974-7796.134309 Guru Teg Bahadur Hospital, University of Delhi, New Delhi, India

272 Urology Annals | Jul - Sep 2014 | Vol 6 | Issue 3