11/23. Routine prostatitis? A case report of long-term foreign body in the prostatic urethra. We report a case of intermittent chronic prostatitis for 13 years. Evaluation revealed a foreign body of the prostatic urethra as the etiology of the symptoms. ( info) |
12/23. Significance of immediate preoperative bacteriuria with pyuria in renal transplant recipients. The presence of bacteriuria and pyuria on urinalysis immediately before renal transplantation has resulted in cancellation of surgery because of concern about post-transplant wound infection. Of 113 renal transplant recipients reviewed 41 (36 per cent) had 5 or more white blood cells per high power field with bacteria in either a voided urine or bladder washout specimen obtained just before grafting. Of those 41 patients 2 suffered postoperative wound infections. Of 72 patients (64 per cent) with less than 5 white blood cells or no bacteria on a preoperative specimen 1 suffered a wound infection (p not significant by Fisher's exact test). Preoperative urine cultures and operative bladder cultures of all 3 patients failed to yield the organisms found later in the wound infections. The factors of sex, insulin-dependent diabetes, delayed graft function, living related versus cadaver donor and pre-transplant splenectomy had no significant relationship to wound infection rates. Renal transplantation can be performed safely in patients who have pyuria and bacteriuria but no signs or symptoms of infection. ( info) |
13/23. Prostatic abscess owing to anaerobic bacteria. abscess of the prostate is seen infrequently. We report a prostatic abscess owing to anaerobic bacteria in a 46-year-old man with a 10-year history of irritable voiding symptoms. Preoperative computerized tomography confirmed the diagnosis of prostatic abscess, which was treated with transurethral resection and broad-spectrum antibiotics. ( info) |
| The authors present a case of a fifteen-year-old boy with urgency, suprapubic pain, hematuria, and pyuria with negative routine urine cultures. cystoscopy revealed gross cystitis, and VCUG showed bilateral reflux and ureteral dilatation. Renal arteriograms, percutaneous renal biopsy, and bladder biopsy also were performed. After finding a positive culture for Ureaplasma, therapy with doxycycline rendered the patient asymptomatic and reflux improved on follow-up VCUG. ureaplasma urealyticum should be considered in patients with symptomatic pyuria and negative routine cultures. Ureteral reflux, reversible with appropriate therapy, may be part of the infectious process. ( info) |
15/23. An etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis); an electron microscopic study. Renal tissues were studied using electron microscopy (EM) and immunofluorescence microscopy (IFM) from three patients who were found to have chronic interstitial nephritis (pyelonephritis) by light microscopy (LM). By LM, 90% of the glomeruli in two patients and all glomeruli in one patient were normal. By EM, glomerular capillaries in all patients revealed generalized fusion of epithelial foot processes. In two patients, IFM for immunoglobulins, third component of complement and fibrinogen were negative. These two patients received corticosteroids for 6 to 12 weeks. In one, proteinuria markedly decreased (from 17.9 to 1.1 gm) in four weeks and in the other follow-up studies of renal histology revealed normal glomeruli and partial restoration of foot processes by LM and EM respectively. Thus, this study offers evidence for lipoid nephrosis (or minimal lesion disease) as an etiology of nephrotic syndrome in chronic interstitial nephritis (pyelonephritis). The impaired renal function in these patients is attributed to tubulo-interstitial disease rather than glomerular pathology. It remains to be determined whether the two disparate pathological conditions have coexisted or chronic interstitial nephritis had led to the appearance of lipoid nephrosis through an unidentified mechanism. ( info) |
16/23. methamphetamine abuse presenting as dysuria following urethral insertion of tablets. foreign bodies are inserted into the male urogenital tract for a variety of motives, and patients may present with symptoms of dysuria, urinary retention, hematuria, discharge, or priapism. Concomitant psychopathology is seen frequently, necessitating a thorough psychiatric assessment with attention to other acts of self-mutilation, suicide attempts, psychosis, or substance abuse. We report the case of an abuser of methamphetamine who inserted a sustained-release form of medication into his urethra, with resulting mechanical and pharmacological trauma. ( info) |
17/23. Medical imaging of renal diseases-suggested indication for different modalities. The diagnostic work-up of the urologic patient must be tailored to the presenting symptom complex, carefully selecting from the many modilities available, those most likely to establish the diagnosis and extent of the suspected lesions. Intravenous urography is the most rewarding initial procedure for many presenting symptoms, including suspected masses, pyuria, hematuria, and flank pain. Nuclear imaging is particularly effective in differentiating renal lobulations from true masses, in demonstrating parenchymal scarring in chronic pyelonephritis when the IVP is equivocal, and in assessing the decrease in perfusion and function in obstructive nephropathy when the IVP is indeterminate. It is the preferred procedure for acute renal infarction and acute tubular necrosis and has a greater sensitivity of detection for renal trauma than the IVP. gallium-67 renal imaging appear helpful in the detection of occult pyelonephritis or interstitial nephritis. However, it cannot differentiate focal acute pyelonephritis from abscess or abscess from neoplasm. Ultrasoneography is the initial procedure of choice in the differentiation of cystic from solid renal masses and in anuria or oliguria. When a kidney fails to visualize by IVP or nuclear imaging, it can confirm or rule out obstruction. In upper tract infections, it may demonstrate renal or perirenal abscess. Although retrograde pyelography is performed less frequently in recent years, it remains extremely useful in confirming and relieving obstructive uropathy and in delineating tumors of the collecting system. Computed tomography effectively demonstrates hydronephrosis, renal abscess, tumors, and cysts and retroperitoneal involvement. More experience is needed to judge the efficiency of "dynamic" CT for the quantification of renal function. Renal angiography remains invaluable as a secondary procedure (as opposed to initial screening) in renal trauma, vascular anomalies, and in renal tumors to delineate the anatomy of the arterial supply and possible renal vein involvement. ( info) |
18/23. Granulomatous sarcoid nephritis: a cause of multiple renal tubular abnormalities. We report the eleventh case of granulomatous sarcoid nephritis and review the previous literature. Although not as commonly recognized as calcium nephropath, granulomatous nephritis may be an important cause of morbidity and mortality in patients with sarcoidosis. Its characteristics are similar to other tubulo-interstitial diseases. Mild to moderate albuminuria, microscopic hematuria and sterile pyuria predominate. hypertension is usually absent and renal size is well preserved. Urinary concentration defects (including nephrogenic diabetes insipidus), renal tubular acidosis and inappropriate glucosuria may also be seen. Interstitial inflammation with non-caseating granulomas, epithelioid and multinucleated giant cells is the usual histologic picture. Intimal thickening is not infrequent and granulomas may occasionally involve the small arteries. Immunofluorescence and electron microscopic findings are non-specific. ( info) |
| Prostate cancer is a frequent concern of the clinician caring for older male patients. The certainty of arriving at the correct diagnosis is related to the presenting patient's risk for prostate cancer, the results of the digital rectal examination, and the value of the serum prostate-specific antigen (PSA). A case report of a patient with acute urinary retention and an elevated PSA is presented. Possible explanations for the elevated PSA are discussed. The clinician's intuitive thought process is compared with an analytic approach using calculated probabilities. Several factors that complicate the estimation of the likelihood of prostate cancer are discussed. ( info) |
20/23. Case report: intermittent sciatic herniation of the ureter. Sciatic herniation is the rarest form of pelvic hernia. Herniation of the ureter into the sciatic foramen is extremely uncommon with only 11 cases reported in the literature. We describe an unusual case of intermittent herniation of the ureter during an intravenous urogram. ( info) |