Cases reported "Urination Disorders"

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11/36. Urinary urgency and frequency: what should a clinician do?

    Obstetrician-gynecologists often care for women with urinary symptoms of urgency and frequency. These symptoms are bothersome and treatable. Although it is rare that serious disease is causative, the clinician must be alert to ominous signs and physical findings. Most patients experience relief of their symptoms after a simple initial evaluation with appropriately directed treatment. A step-wise evaluation includes the directed history and physical, assessment of urinary habits, typically with a urinary diary, and occasionally an assessment of voiding efficiency, typically with a postvoid residual. Treatments may include myofascial therapy when trigger points are present on physical examination. Behavioral therapy and pharmaceuticals also play an important role. Persistent symptoms, hematuria, severe de novo postoperative symptoms, and ominous physical findings may warrant specialty consultation.
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12/36. Chronic pyonephrosis associated with renal neovascularisation.

    The spectrum of renal tract infections is wide. When the kidney has been severely damaged, the radiological findings may suggest a malignancy. To report a case of chronic pyonephrosis, which even at exploration appeared to be a malignancy. The case record of the patient as well as the literature were reviewed and reported. A 25 year-old woman presented with a 5-year history of left lumbar pain, urinary frequency and intermittent total haematuria. The intravenous urography showed non-function in the left kidney harbouring a calculus. Treatment was delayed for poor finances. At laparotomy a huge renal mass invading the colonic mesentery and showing neovascularisation was removed. The final diagnosis was chronic pyonephrosis. She recovered from postoperative septicaemia. Neovascularisation is a feature of malignant disease mediated by angiogenesis factors. These factors are probably present in chronic inflammation. It is suggested that for nephrectomy, prophylactic antibiotics should be used. There is also a need for histopathological examination of every specimen removed at operation.
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13/36. Long-term chronic complications from Stamey endoscopic bladder neck suspension: a case series.

    Purpose/objective Long-term complications from anti-incontinence surgical procedures are rarely reported. We report on delayed presentation of complications relating to the synthetic bolster placed for the Stamey bladder neck suspension. MATERIALS AND methods: patients undergoing re-operative surgery following prior Stamey endoscopic bladder neck suspension were selected from a surgical database. Four women with lower urinary tract and/or vaginal symptoms following prior Stamey endoscopic bladder neck suspension were identified. All patients had undergone removal of the bolster material by a single surgeon (ESR) at re-operation. Preoperative, operative, and postoperative inpatient and outpatient records were reviewed. RESULTS: patients presented with a variety of symptoms including urinary incontinence, recurrent cystitis, vaginitis, and urinary frequency at 9, 11, 11, and 12 years after Stamey bladder neck suspension. In addition, two patients presented with recurrent, intermittent bloody vaginal discharge and two patients complained of recurrent urinary tract infections and irritative voiding symptoms. All patients underwent transvaginal excision of the Dacron bolster. Three patients also underwent placement of an autologous pubovaginal sling for symptomatic recurrent stress urinary incontinence. At a mean follow-up of 30 months all four patients were improved. There was no recurrence of vaginal discharge or urinary tract infections. Irritative voiding symptoms resolved. CONCLUSIONS: Delayed complications from surgically implanted synthetic materials can present many years after initial implantation. The clinical findings are often subtle and require a high degree of suspicion. vaginal discharge and irritative urinary symptoms in patients with even a remote history of Stamey bladder neck suspension should prompt a thorough vaginal exam and cystoscopy. Excision of the bolsters can be performed and is usually followed by symptomatic improvement.
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14/36. Clinical manifestations and functional outcomes in children with eosinophilic cystitis.

    PURPOSE: Eosinophilic cystitis is a rare disorder, with fewer than 30 pediatric cases reported in the literature. We describe our experience with pediatric eosinophilic cystitis during a 20-year period. MATERIALS AND methods: Four children referred to our institution were subsequently diagnosed with eosinophilic cystitis between 1984 and 2004. A retrospective chart review was performed to assess clinical presentation, diagnosis, treatment and outcomes. RESULTS: Mean patient age at presentation was 10.8 years (range 5 to 18) and male-to-female ratio was 3:1. All 4 patients presented with irritative urinary symptoms, including 3 with dysuria and/or gross hematuria and 2 with urinary frequency, lower abdominal pain and/or a concomitant urinary tract infection. Allergic diseases (asthma, allergic rhinitis, etc) were present in 3 patients, and a formal allergen skin test was positive in 2 of those tested. A bladder mass mimicking malignancy was documented in 2 patients. Three patients had symptom resolution with conservative treatment, while 1 had development of an unremitting tumefactive process that eventually required partial cystectomy and bladder augmentation. CONCLUSIONS: Eosinophilic cystitis is a rare condition with a wide range of clinical manifestations. Children can present with a bladder mass mimicking sarcoma, underscoring the need for biopsy before diagnosis and treatment of a presumed oncological process. The condition usually follows a benign course, although unremitting progression remains a possibility.
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15/36. Endocervicosis of the bladder: a case report.

    BACKGROUND: Endocervicosis of the bladder is a rare, benign lesion characterized by mucinous endocervical epithelium within the detrusor muscle of the bladder. CASE: A 48-year-old woman presented with a history of dysuria for the past week and pelvic pain for the past 6 months. Her history was significant for 2 prior cesarean sections. Transvaginal pelvic ultrasound revealed a mass protruding into the bladder. cystoscopy and magnetic resonance imaging of the pelvis confirmed this finding. A total abdominal hysterectomy ing. A total abdominal hysterectomy and partial cystectomy were performed. pathology of the bladder wall revealed endocervicosis. The patient remained symptom free at 6 months. CONCLUSION: Endocervicosis of the bladder wall is a rare lesion, and the diagnosis is difficult to make both clinically and pathologically. The diagnosis should be considered in any woman presenting with pelvic pain, dysuria and frequency. Gynecologists should be aware of this condition for proper diagnostic and surgical management.
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16/36. Anterior urethral valves.

    We studied the clinical presentation and management of four patients with anterior urethral valves; a rare cause of urethral obstruction in male children. One patient presented antenatally with oligohydramnios, bilateral hydronephrosis and bladder thickening suggestive of an infravesical obstruction. Two other patients presented postnatally at 1 and 2 years of age, respectively, with poor stream of urine since birth. The fourth patient presented at 9 years with frequency and dysuria. diagnosis was established on either micturating cystourethrogram (MCU) (in 2) or on cystoscopy (in 2). All patients had cystoscopic ablation of the valves. One patient developed a postablation stricture that was resected with an end-to-end urethroplasty. He had an associated bilateral vesicoureteric junction (VUJ) obstruction for which a bilateral ureteric reimplantation was done at the same time. On long-term follow-up, all patients demonstrated a good stream of urine. The renal function is normal. patients are continent and free of urinary infections. Anterior urethral valves are rare obstructive lesions in male children. The degree of obstruction is variable, and so they may present with mild micturition difficulty or severe obstruction with hydroureteronephrosis and renal impairment. Hence, it is important to evaluate the anterior urethra in any male child with suspected infravesical obstruction. The diagnosis is established by MCU or cystoscopy and the treatment is always surgical, either a transurethral ablation or an open resection. The long-term prognosis is good.
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17/36. Unusual appendiceal pathology presenting as urologic disease.

    We report on 3 cases of unusual appendiceal pathology presenting as urologic disease: 2 cases were benign mucoceles and 1 a malignant mucocele or cystadenocarcinoma of the appendix. Two cases presented as pelvic masses causing urinary frequency and the third with fever and hydronephrosis. The appendix must remain in the differential diagnosis for both acute and chronic disease processes.
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18/36. Pelvic lipomatosis in a female: diagnosis and initial therapy.

    The extremely rare case of pelvic lipomatosis in a women is reported (4 cases in the literature). The patient suffered from symptoms of irritable bladder. Treatment included hysterectomy and extension of the bladder resulting in a significant reduction of frequency. Prognostic criteria of the progressive benign disease and therapeutic modalities are discussed.
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19/36. Irritability and dysuria in infants with idiopathic hypercalciuria.

    Idiopathic hypercalciuria (IH) is being diagnosed with increasing frequency in the pediatric population and occurs in approximately 2.9-6.2% of normal children. The majority of children with IH are asymptomatic; however, the most common clinical presentation is that of isolated hematuria (gross or microscopic). The prevalence, presentation and clinical course of IH is less well established in infants. We have recently seen two young infants with IH who had dysuria on presentation. Their hypercalciuria was difficult to manage and required frequent manipulations of drug therapy and diet restrictions. These cases emphasize the importance of evaluating infants with dysuria and irritability for IH, even in the absence of hematuria. Further studies are needed to establish the prevalence and classical presentation of IH in this population, and to determine the necessary duration of therapy.
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20/36. Voiding dysfunction due to neurosyphilis.

    Three patients with neurosyphilis presenting with urinary frequency, incontinence and voiding dysfunction were investigated. Unlike the previously reported finding of areflexia in tabes dorsalis, all 3 had hypocompliant detrusor hyper-reflexia with detrusor-sphincter dyssynergia and post-micturition residual urine. One patient also had bladder neck dyssynergia treated by bladder neck incision. The other 2 patients were initially managed by intermittent catheterisation but 1 ultimately underwent urinary diversion. The clinical relevance of these findings and the treatment of this condition are discussed.
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