DOCSLIB.ORG

Malacoplakia in Urologic Specimen

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Malacoplakia in Urologic Specimen Research Article JOJ uro & nephron Volume 3 Issue 2 - April 2017 Copyright © All rights are reserved by Sierra Pablo DOI: 10.19080/JOJUN.2017.03.555607 Malacoplakia in Urologic Specimen Sierra Pablo*, Henao Matilde, Gaviria Federico and Velez Alejandro Department of Urology and Pathology, Hospital Pablo Tobón Uribe, Universidad CES, Colombia Submission: March 30, 2017; Published: May 30, 2017 *Corresponding author: Sierra Pablo, Department of Urology and Pathology, Hospital Pablo Tobón Uribe, Universidad CES, Colombia, Email: Abstract abnormal macrophage function in response to a bacterial infection. This rare entity is characterized by one o multiple tumoral growths in any part Malacoplakiaof the body and is anis usuallyinflammatory misdiagnosed condition as characterizeda malignant condition. by yellow–brown The genitourinary plaques with tract granulomatous is frequently involved lesions. It(up probably to 75%). results Pathologic from studiesThere of these is a very lesions sparse show evidence tissue infiltrated published by in macrophagesthe literature, and mostly hystiocytes case reports. with intracytoplasmic Previously in 2006 inclusions we reported (Michaelis-Gutmann 6 cases of malakoplakia, bodies). now we present an update with six additional cases to a total of twelve events in the same institution during a period of 17 years. Keywords: Malacoplakia; Urinary Tract infections; Prostatitis Abbreviations: MLP: Malacoplakia; MGB: Michaelis–Gutmannbodies; UTI: Urinary Tract Infection; ATB: Antibiotics Introduction visible changes on ultrasound, CT and MRI of the involved organ Malakoplakia is extremely rare granulomatous and promote thickening of the bladder wall forcing erroneous treatments and in some cases radical surgeries [7-9]. musculoskeletal, respiratory, and gastrointestinal and specially inflammatory condition that can affect many systems including the urinary tract, most commonly the bladder. It is considered to Patients and Methods develop as a result of a defective immune response to bacterial A retrospective review to identify patients with a diagnosis agents, the most common Escherichia coli [1-3]. Although more of malacoplakia of the urinary tract was performed, 12 patients commonly affects genitourinary tract, isolated cases have been were found to have this diagnosis along 17 years in Hospital Pablo reported in colon, stomach, lung, liver, bone, uterus and skin [4]. Tobon Uribe and Dinamica IPS in Medellin, Colombia. All cases In the histopathological examination, malakoplakia is where evaluated by the same uropathologist and challenging characterized by the presence of foamy histiocytes with cases where reviewed by and experienced uropathologist in a distinctive basophilic inclusions, which are known as Michaelis– reference center in US. Records were retrieved and complete Gutmannbodies (MGB), this name after whom described the clinical history reviewed and described in this case series as condition in 1902 [5]. It was Von Hansemann in 1903 who employed the word malakoplakia (from the greekmalakós, soft, images were included were available. This study was conducted well as laboratory findings, pathology specimen and radiology under the Hospital Pablo Tobon Uribe institutional review board macroscopic aspect. and plakos, plaque) [6] to define this process according to its Malakoplakia of the genitourinary system is more commonly and Apatients systematic confidentiality MEDLINE/Pubmed was assured. review was performed on the 27th of may 2016 according to the PRISMA guidelines. The and seventh decades of life but is has been described also in main search terms were “malakoplakia” and“urinary tract”. 267 diagnosed in women. It is usually observed between the fifth pediatric and other unique group such as kidney transplant articles were retrieved, 77 articles remained after applying immunosuppressed patients. limits for papers published after 2000. The search result was It is a challenging clinical diagnosis that is usually mistaken Spanish literature, abstracts were read and 33 publications for malignancy, it could lead to a formation of a mass anywhere in first screened for relevance by title and limited to English and of interest were selected for full text review. The search was the urinary tract, elevate prostate specific antigen (PSA), cause JOJ uro & nephron 3(2): JOJUN.MS.ID.5555607(2017) 001 JOJ Urology & Nephrology non responsive to pharmacologic therapy. Interestingly, 3 suggested by important publications until no additional patients had PSA elevation and a transrectal ultrasound guided complemented with own files articles, hand search and articles papers were retrieved. The search sensitivity was evaluated by biopsy was performed, all evidenced MGB in the pathologic to the authors and those cited in previous seminal reviews. If concurrent adenocarcinoma of the prostate and underwent a comparing the articles identified against those already known slides confirming malakoplakia, one patient was found with an article was missed, the title and abstract where carefully radical prostatectomy. One of the patients that did not have PSA reviewed to identify terms that would improve the sensitivity elevation was taken to transurethral resection of the prostate of the search. and was found with prostate cancer along with malacoplakia. Results The only pediatric patient is a 4 month old male with an enlarging testicular mass confounded with a neoplasia of the Twelve patients were found to have malakoplakia, median testis at doppler US, serum tumor markers were negative, he was age at presentation was 66.5 years, most patients being older than 35 years (11/12) and only one patient in the pediatric age. Most common organ involved was prostate, in fact taken to inguinal radical orchiectomy and the final pathologic lymphocytes, plasmocytes, giant cell and hystiocytes with MGB 7/12 patients had compromise of this gland, all of them had specimen showed a benign inflammatory process with abundant that suggest the diagnosis of MLP, he had a positive urine culture lower urinary tract symptoms (LUTS), all required surgical for E. Coli.Patients characteristics are listed on Table 1. intervention due to recurrent UTI and voiding obstruction Table 1: Malakoplakia cases clinical features. Age Micro Pathology and Sex Site Radiology Size (cm) Symptoms UTI Treatment Follow up (Years) organism lab MGB, Heterogeneous Scrotal M 0.3 Testicle 3x2 + E. Coli Orchiectomy Uneventful mass on US swelling cells inflammatory ABSCESSED Nephrectomy Kidney resection of MGB, F 52 Psoas 15 pain, fever + E. Coli psoas and 3rd Uneventful PERITONEAL Hystiocytes Duodenum MASS,RETRO- PSOAS weightRight flank loss portion of AND KIDNEY duodenum PSA 6.3 LUTS Prostate Glandular/ M 60 Prostate - urinary - - TURP Uneventful Enlargement stromal retention hyperplasia, MGB PSA 263 LUTS TRUS biopsy Prostate Hematuria Glandular/ M 67 Prostate - - - open Uneventful Enlargement urinary stromal retention prostatectomy hyperplasia, MGB PSA 10 LUTS Prostate urinary TRUS biopsy Hystiocytes M 70 Prostate - + E. Coli Uneventful Enlargement retention TURP chronic UTI MGB inflammation, TRUS Biopsy, Prostate Elevated Prostate M 70 Prostate - - - radical Uneventful Enlargement PSA Adenocarcinoma prostatectomy Thickened Recurrent F 76 Bladder irregular - + E. Coli ATB MGB Uneventful UTI, LUTS bladder wall How to cite this article: Sierra P, Henao M, Gaviria F, Velez Alejandro. Malacoplakia in Urologic Specimen. JOJ uro & nephron. 2017; 3(2): 555607. 002 DOI: 10.19080/JOJUN.2017.03.555607. JOJ Urology & Nephrology Prostate Prostate cancer M 66 Prostate - LUTS - - TURP Uneventful Enlargement and MGB Prostate M 62 Prostate - LUTS - - Prostatectomy MGB Uneventful Enlargement Prostate Radical M 68 Prostate - LUTS - - Prostate cancer Uneventful Enlargement prostatectomy Recurrent Recurrent F 38 Bladder VUR - + E. Coli TURBT - ATB MGB UTI UTI Cervix, Uterus, Functional F 85 Vagina, CT Pelvic mass 8x12x9 + E.Coli ATB MGB Uneventful decline Bladder, ureters Six of patients had E. Coli proven UTI by urine culture (50%), this percentage is expected be even higher but unfortunately showed yellow soft plaques with multiple foci affecting the cystogram revealed vesicourethral reflux (VUR) and cystoscopy some of the patients didn’t have urine culture reports previous bladder (Figure 1), biopsy showed MGB the patient received to the initiation of antibiotics. ATB, unfortunately symptoms recurred, at control cystoscopy we found larger lesions that required transurethral resection, Discussion Malakoplakia is a rare clinical entity, accurate diagnosis satisfactory with lower episodes of UTI after resection and pathologic examination confirmed the etiology. Outcomes were relies on biopsies or surgery specimen reviewed by experienced continuous prophylactic ATB. Other structures can be affected pathologists. MLP features Hansemanncells , which are by malakoplakia, Love et al. [10] described MLP of the urethra hystiocytes with small nuclei and granular acidophilic causing strictures and accounting as an exceptional etiology for cytoplasms and MGB, which are basophilic periodic acid- this disease, surgery was not necessary in this particular case. Schiff, diastase-resistant and calcific inclusions seen within search for the pathognomonic characteristics of the disease the hystiocytes8.This are not usual findings and requires active and a good clinical and pathological correlation. Apparently the pathogenesis is explained because impaired host defenses and a defect in phagocytosis
Load more

Recommended publications
  • USMLE – What's It
    Purpose of this handout Congratulations on making it to Year 2 of medical school! You are that much closer to having your Doctor of Medicine degree. If you want to PRACTICE medicine, however, you have to be licensed, and in order to be licensed you must first pass all four United States Medical Licensing Exams. This book is intended as a starting point in your preparation for getting past the first hurdle, Step 1. It contains study tips, suggestions, resources, and advice. Please remember, however, that no single approach to studying is right for everyone. USMLE – What is it for? In order to become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners (NBME). These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are four separate exams which must be passed in order to be eligible for medical licensure: Step 1, usually taken after the completion of the second year of medical school; Step 2 Clinical Knowledge (CK), this is usually taken by December 31st of Year 4 Step 2 Clinical Skills (CS), this is usually be taken by December 31st of Year 4 Step 3, typically taken during the first (intern) year of post graduate training. Requirements other than passing all of the above mentioned steps for licensure in each state are set by each state’s medical licensing board. For example, each state board determines the maximum number of times that a person may take each Step exam and still remain eligible for licensure.
    [Show full text]
  • WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA).
    [Show full text]
  • Surgical Treatment of Urinary Incontinence in Men
    Committee 13 Surgical Treatment of Urinary Incontinence in Men Chairman S. HERSCHORN (Canada) Members H. BRUSCHINI (Brazil), C.COMITER (USA), P.G RISE (France), T. HANUS (Czech Republic), R. KIRSCHNER-HERMANNS (Germany) 1121 CONTENTS I. INTRODUCTION VIII. TRAUMATIC INJURIES OF THE URETHRA AND PELVIC FLOOR II. EVALUATION PRIOR TO SURGICAL THERAPY IX. CONTINUING PEDIATRIC III. INCONTINENCE AFTER RADICAL PROBLEMS INTO ADULTHOOD: THE PROSTATECTOMY FOR PROSTATE EXSTROPHY-EPISPADIAS COMPLEX CANCER X. DETRUSOR OVERACTIVITY AND IV. INCONTINENCE AFTER REDUCED BLADDER CAPACITY PROSTATECTOMY FOR BENIGN DISEASE XI. URETHROCUTANEOUS AND V. SURGERY FOR INCONTINENCE IN RECTOURETHRAL FISTULAE ELDERLY MEN VI. INCONTINENCE AFTER XII. THE ARTIFICIAL URINARY EXTERNAL BEAM RADIOTHERAPY SPHINCTER (AUS) ALONE AND IN COMBINATION WITH SURGERY FOR PROSTATE CANCER XIII. SUMMARY AND RECOMMENDATIONS VII. INCONTINENCE AFTER OTHER TREATMENT FOR PROSTATE CANCER REFERENCES 1122 Surgical Treatment of Urinary Incontinence in Men S. HERSCHORN, H. BRUSCHINI, C. COMITER, P. GRISE, T. HANUS, R. KIRSCHNER-HERMANNS high-intensity focused ultrasound, other pelvic I. INTRODUCTION operations and trauma is a particularly challenging problem because of tissue damage outside the lower Surgery for male incontinence is an important aspect urinary tract. The artificial sphincter implant is the of treatment with the changing demographics of society most widely used surgical procedure but complications and the continuing large numbers of men undergoing may be more likely than in other areas and other surgery and other treatments for prostate cancer. surgical approaches may be necessary. Unresolved problems from pediatric age and patients with Basic evaluation of the patient is similar to other areas refractory incontinence from overactive bladders may of incontinence and includes primarily a clinical demand a variety of complex reconstructive surgical approach with history, frequency-volume chart or procedures.
    [Show full text]
  • (Part 1): Management of Male Urethral Stricture Disease
    EURURO-9412; No. of Pages 11 E U R O P E A N U R O L O G Y X X X ( 2 0 2 1 ) X X X – X X X ava ilable at www.sciencedirect.com journa l homepage: www.europeanurology.com Review – Reconstructive Urology European Association of Urology Guidelines on Urethral Stricture Disease (Part 1): Management of Male Urethral Stricture Disease a, b c d Nicolaas Lumen *, Felix Campos-Juanatey , Tamsin Greenwell , Francisco E. Martins , e f a c g Nadir I. Osman , Silke Riechardt , Marjan Waterloos , Rachel Barratt , Garson Chan , h i a j Francesco Esperto , Achilles Ploumidis , Wesley Verla , Konstantinos Dimitropoulos a b Division of Urology, Gent University Hospital, Gent, Belgium; Urology Department, Marques de Valdecilla University Hospital, Santander, Spain; c d Department of Urology, University College London Hospital, London, UK; Department of Urology, Santa Maria University Hospital, University of Lisbon, e f Lisbon, Portugal; Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK; Department of Urology, University Medical Center Hamburg- g h Eppendorf, Hamburg, Germany; Division of Urology, University of Saskatchewan, Saskatoon, Canada; Department of Urology, Campus Biomedico i j University of Rome, Rome, Italy; Department of Urology, Athens Medical Centre, Athens, Greece; Aberdeen Royal Infirmary, Aberdeen, UK Article info Abstract Article history: Objective: To present a summary of the 2021 version of the European Association of Urology (EAU) guidelines on management of male urethral stricture disease. Accepted May 15, 2021 Evidence acquisition: The panel performed a literature review on these topics covering a time frame between 2008 and 2018, and used predefined inclusion and exclusion criteria Associate Editor: for the literature to be selected.
    [Show full text]
  • UIJ Urotoday International Journal® the Short-Term Outcome of Urethral Stricture Disease Management in HIV and Non-HIV Infected Patients: a Comparative Study
    UIJ UroToday International Journal® The Short-Term Outcome of Urethral Stricture Disease Management in HIV and Non-HIV Infected Patients: A Comparative Study Mohamed Awny Labib, Michael Silumbe, Kasonde Bowa Submitted April 30, 2012 - Accepted for Publication December 27, 2012 ABSTRACT Purpose: This study intends to compare short-term outcomes of treatment of urethral stricture disease between human immunodeficiency virus (HIV) seropositive and HIV seronegative patients at the University Teaching Hospital (UTH) in Lusaka. Methods: This was a prospective cohort study conducted on patients presenting with urethral stricture disease at the UTH, Lusaka, Zambia, between October 2009 and December 2010. One arm included HIV seropositive patients and the other arm had HIV seronegative patients. The recruited patients underwent urethral dilatation, anastomotic urethroplasty, and staged urethroplasty. They were followed-up postoperatively for 6 months, and recurrence and complication rates were compared between the 2 groups. Other parameters studied included patient demographics, cluster of differentiation (CD4) cell counts in positive patients, HIV World Health Organization (WHO) stages, stricture etiology, stricture sites, and stricture lengths. The collected data was analyzed using SPSS 16. Results: A total of 71 patients with a mean age of 38.04 years who had urethral stricture disease were recruited for this study. Of the patients, 37% (26) were HIV seropositive while 63% (45) were seronegative, and 53.8% (14) of the seropositive patients were on highly active antiretroviral therapy (HAART). Of the urethral strictures, 45% (32) resulted from urethritis, and the prevalence of HIV in patients presenting with post-urethritis stricture disease was 50% (16/32). Of the strictures, 73.2% (N = 52) were located in the bulbar urethra, 19.7% (N = 14) were in the penile urethra, and 5.6% (N = 4) were located in the membranous urethra.
    [Show full text]
  • Lesions of the Female Urethra: a Review
    Please do not remove this page Lesions of the Female Urethra: a Review Heller, Debra https://scholarship.libraries.rutgers.edu/discovery/delivery/01RUT_INST:ResearchRepository/12643401980004646?l#13643527750004646 Heller, D. (2015). Lesions of the Female Urethra: a Review. In Journal of Gynecologic Surgery (Vol. 31, Issue 4, pp. 189–197). Rutgers University. https://doi.org/10.7282/T3DB8439 This work is protected by copyright. You are free to use this resource, with proper attribution, for research and educational purposes. Other uses, such as reproduction or publication, may require the permission of the copyright holder. Downloaded On 2021/09/29 23:15:18 -0400 Heller DS Lesions of the Female Urethra: a Review Debra S. Heller, MD From the Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ Address Correspondence to: Debra S. Heller, MD Dept of Pathology-UH/E158 Rutgers-New Jersey Medical School 185 South Orange Ave Newark, NJ, 07103 Tel 973-972-0751 Fax 973-972-5724 [email protected] There are no conflicts of interest. The entire manuscript was conceived of and written by the author. Word count 3754 1 Heller DS Precis: Lesions of the female urethra are reviewed. Key words: Female, urethral neoplasms, urethral lesions 2 Heller DS Abstract: Objectives: The female urethra may become involved by a variety of conditions, which may be challenging to providers who treat women. Mass-like urethral lesions need to be distinguished from other lesions arising from the anterior(ventral) vagina. Methods: A literature review was conducted. A Medline search was used, using the terms urethral neoplasms, urethral diseases, and female.
    [Show full text]
  • | Oa Tai Ei Rama Telut Literatur
    |OA TAI EI US009750245B2RAMA TELUT LITERATUR (12 ) United States Patent ( 10 ) Patent No. : US 9 ,750 ,245 B2 Lemire et al. ( 45 ) Date of Patent : Sep . 5 , 2017 ( 54 ) TOPICAL USE OF AN ANTIMICROBIAL 2003 /0225003 A1 * 12 / 2003 Ninkov . .. .. 514 / 23 FORMULATION 2009 /0258098 A 10 /2009 Rolling et al. 2009 /0269394 Al 10 /2009 Baker, Jr . et al . 2010 / 0034907 A1 * 2 / 2010 Daigle et al. 424 / 736 (71 ) Applicant : Laboratoire M2, Sherbrooke (CA ) 2010 /0137451 A1 * 6 / 2010 DeMarco et al. .. .. .. 514 / 705 2010 /0272818 Al 10 /2010 Franklin et al . (72 ) Inventors : Gaetan Lemire , Sherbrooke (CA ) ; 2011 / 0206790 AL 8 / 2011 Weiss Ulysse Desranleau Dandurand , 2011 /0223114 AL 9 / 2011 Chakrabortty et al . Sherbrooke (CA ) ; Sylvain Quessy , 2013 /0034618 A1 * 2 / 2013 Swenholt . .. .. 424 /665 Ste - Anne -de - Sorel (CA ) ; Ann Letellier , Massueville (CA ) FOREIGN PATENT DOCUMENTS ( 73 ) Assignee : LABORATOIRE M2, Sherbrooke, AU 2009235913 10 /2009 CA 2567333 12 / 2005 Quebec (CA ) EP 1178736 * 2 / 2004 A23K 1 / 16 WO WO0069277 11 /2000 ( * ) Notice : Subject to any disclaimer, the term of this WO WO 2009132343 10 / 2009 patent is extended or adjusted under 35 WO WO 2010010320 1 / 2010 U . S . C . 154 ( b ) by 37 days . (21 ) Appl. No. : 13 /790 ,911 OTHER PUBLICATIONS Definition of “ Subject ,” Oxford Dictionary - American English , (22 ) Filed : Mar. 8 , 2013 Accessed Dec . 6 , 2013 , pp . 1 - 2 . * Inouye et al , “ Combined Effect of Heat , Essential Oils and Salt on (65 ) Prior Publication Data the Fungicidal Activity against Trichophyton mentagrophytes in US 2014 /0256826 A1 Sep . 11, 2014 Foot Bath ,” Jpn .
    [Show full text]
  • Surgical Treatment of Urinary Incontinence in Men
    CHAPTER 19 Committee 15 Surgical Treatment of Urinary Incontinence in Men Chairman S. HERSCHORN (CANADA) Co-Chair J. THUROFF (GERMANY) Members H. BRUSCHINI (BRAZIL), P. G RISE (FRANCE), T. HANUS (CZECH REPUBLIC), H. KAKIZAKI (JAPAN), R. KIRSCHNER-HERMANNS (GERMANY), V. N ITTI (USA), E. SCHICK (CANADA) 1241 CONTENTS IX. CONTINUING PEDIATRIC I. INTRODUCTION AND SUMMARY PROBLEMS INTO ADULTHOOD: THE EXSTROPHY-EPISPADIAS COMPLEX II. EVALUATION PRIOR TO SURGICAL THERAPY X. DETRUSOR OVERACTIVITY AND REDUCED BLADDER CAPACITY III. INCONTINENCE AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER XI. URETHROCUTANEOUS AND RECTOURETHRAL FISTULAE IV. INCONTINENCE AFTER XII. THE ARTIFICIAL URINARY PROSTATECTOMY FOR BENIGN SPHINCTER (AUS) DISEASE V. SURGERY FOR INCONTINENCE XIII. NEW TECHNOLOGY IN ELDERLY MEN XIV. SUMMARY AND VI. INCONTINENCE AFTER RECOMMENDATIONS EXTERNAL BEAM RADIOTHERAPY ALONE AND IN COMBINATION WITH SURGERY FOR PROSTATE REFERENCES CANCER VIII. TRAUMATIC INJURIES OF THE URETHRA AND PELVIC FLOOR 1242 Surgical Treatment of Urinary Incontinence in Men S. HERSCHORN, J. THUROFF H. BRUSCHINI, P. GRISE, T. HANUS, H. KAKIZAKI, R. KIRSCHNER-HERMANNS, V. N ITTI, E. SCHICK ry, other pelvic operations and trauma is a particular- I. INTRODUCTION AND SUMMARY ly challenging problem because of tissue damage outside the lower urinary tract. The artificial sphinc- ter implant is the most widely used surgical procedu- Surgery for male incontinence is an important aspect re but complications may be more likely than in of treatment with the changing demographics of other areas and other surgical approaches may be society and the continuing large numbers of men necessary. Unresolved problems from the pediatric undergoing surgery for prostate cancer. age group and patients with refractory incontinence Basic evaluation of the patient is similar to other from overactive bladders may demand a variety of areas of incontinence and includes primarily a clini- complex reconstructive surgical procedures.
    [Show full text]
  • Obstructive Uropathy in Children – an Update RANJIT RANJAN ROY1, MD FIROZ ANJUM2, SHAHANA FERDOUS3
    BANGLADESH J CHILD HEALTH 2017; VOL 41 (2): 110-116 Obstructive Uropathy in Children – An Update RANJIT RANJAN ROY1, MD FIROZ ANJUM2, SHAHANA FERDOUS3 Abstract: Obstructive nephropathy is a structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction. Urinary tract obstruction can result from congenital (anatomic) lesion or can be caused by trauma, neoplasia, calculi, inflammation or surgical procedures, although most childhood obstructive lesions are congenital.The clinical features in most of the patients are due to consequences of the obstruction2. Obstruction of the urinary tract generally causeshydronephrosis, which is typically asymptomatic in its early phase. Renal USG gives information about urinary tract dilatation, renal cortical thickness, calyx size, diameter of pelvis, ureter, bladder thickness, tumor & calculi and doppler USG for evaluation of aberrentvessles. Once obstructive nephropathy has been identified therapy focuses on the rapid restoration of normal urine flow either by medical or surgical intervention. Key words: Obstructive Uropathy, Posterior urethral valve, pyelonephritis, IVU, MCU Introduction: urinary tract obstruction impairs renal growth & Urinary tract obstruction refers to as restriction to the development.1 The approach to obstructive urinary outflow that if not managed satisfactorily, leads nephropathy should be to detect site of obstruction, to progressive renal damage. Obstructive uropathy is to find out whether obstruction is complete or partial, an important cause of end stage renal disease unilateral or bilateral, to findthe cause of obstruction requiring renal replacement therapy.1 The kidney is and to decide need forsurgery and to plan the medical an indispensable organ for maintaining homeostasis. treatment.4 The renal system plays diverse role including hormonogenesis, metabolism, detoxification & Etiology: excretion of urine which contains agents that may be Urinary tract obstruction can result from congenital injurious to the body.
    [Show full text]
  • Pelvic Malakoplakia Presenting As Endometrial Cancer: a Case Report
    Case report Obstet Gynecol Sci 2020;63(4):538-542 https://doi.org/10.5468/ogs.19245 pISSN 2287-8572 · eISSN 2287-8580 Pelvic malakoplakia presenting as endometrial cancer: a case report Jeong Soo Cho, MD, Hye In Kim, MD, Jung Yun Lee, MD, Eun Ji Nam, MD, Sunghoon Kim, MD, Young Tae Kim, MD, Sang Wun Kim, MD, PhD Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, Korea Malakoplakia is a rare granulomatous, inflammatory disease generally manifesting as ulcers of the urogenital tract, especially in the bladder, but it can occur in any part of the body. Because of its varied clinical presentations, malakoplakia is considered for differential diagnosis upon suspicion. The final diagnosis is confirmed by the presence of Michaelis-Gutmann bodies. We report a case of pelvic malakoplakia accompanied by left lower quadrant pain that was misdiagnosed as endometrial cancer with pelvic mass based on imaging studies. The patient underwent dilatation and curettage, and the pathology report revealed no malignancy. Because of persistent pain and septic shock, she underwent a debulking operation to remove the mass. Histopathologic examination revealed malakoplakia. For postoperative management, she received broad-spectrum antibiotics, but abdominal pelvic computerized tomography performed on postoperative day 9 revealed pelvic mass recurrence. To the best of our knowledge, this is the only rare case report of pelvic malakoplakia mimicking endometrial cancer. Keywords: Malakoplakia; Endometrial cancer; Pelvic inflammatory disease; Menopause Introduction We present a case which was first suspected as a severe infection involving left ovary and salpinx and as endometrial Malakoplakia was first announced by Michaelis and Gut- cancer later.
    [Show full text]
  • Urinary Retention in Adults: Diagnosis and Initial Management Brian A
    Urinary Retention in Adults: Diagnosis and Initial Management BRIAN a. SELIUS, DO, and rAJESH SUBEDI, MD, Northeastern Ohio Universities College of Medicine, St. Elizabeth Health Center, Youngstown, Ohio Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neuro- logic, or other. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alpha- adrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organs. A thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases. Initial management includes bladder catheterization with prompt and com- plete decompression. Men with acute urinary retention from benign prostatic hyperplasia have an increased chance of returning to normal voiding if alpha blockers are started at the time of catheter insertion. Suprapubic catheteriza- tion may be superior to urethral catheterization for short-term management and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection. Patients with chronic urinary retention from neurogenic bladder should be able to manage their condition with clean, intermittent self-catheterization; low-friction catheters have shown benefit in these patients. Definitive management of urinary retention will depend on the etiology and may include surgical and medical treatments. (Am Fam Physician. 2008;77(5):643-650. Copyright © 2008 American Academy of Family Physicians.) rinary retention is the inabil- physician to make an accurate diagnosis ity to voluntarily urinate.
    [Show full text]
  • Investigation of the Neurogenic Bladder
    6 6Journal ofNeurology, Neurosurgery, anid Psychiatry 1996;60:6-13 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.60.1.6 on 1 January 1996. Downloaded from NEUROLOGICAL INVESTIGATIONS Investigation of the neurogenic bladder Clare J Fowler Methods of examination which have been analogue signals but with the advances in used to investigate the neurogenic bladder electronics and development of microchip include tests of bladder function, so-called technology the machines have become pro- "urodynamics", and neurophysiological tests gressively more complex, more "intelligent", of sphincter and pelvic floor innervation. A and mostly easier to use. Today measured possible consequence of a neurogenic bladder is pressures are digitised allowing on line, real damage to the upper urinary tract but the time computer analysis of signals. investigation of such complications is essen- During the development of urodynamics an tially urological and is only briefly mentioned important advance came with the introduction in this review. of facilities to record pressure measurements superimposed on the fluoroscopic appearances of the bladder, a "videocystometrogram". History of the development of This combination provides a complete picture investigations of the behaviour of the bladder both during URODYNAMICS filling and emptying although it is expensive The term "urodynamics" encompasses any and exposes the patient to x rays. Much can be investigation of urinary tract function although learnt from simple cystometry alone and it is it is often used colloquially as a synonym for this investigation which is now a standard cystometry. Cystometry, the measurement of facility in almost every district general hospital bladder pressure, has been the main tool used with a urology department.
    [Show full text]