Giant vesical calculus presenting with azotaemia and anuria

Giant vesical calculus is a rare clinical entity in modern urological practice. Vesical calculi are usually secondary to bladder outlet obstruction. The usual clinical presentation is with recurrent urinary tract infection, haematuria or with retention of urine. We report an elderly male patient who presented with azotaemia and anuria as a result of bilateral obstructive uropathy due to a giant vesical calculus.     

Two cases of urinary retention secondary to aseptic meningitis]

We report two rare cases of urinary retention secondary to aseptic meningitis. Case I was in a 13-year-old boy admitted to the pediatric department due to aseptic meningitis. Eight days after his admission, urinary retention developed and cystometry showed atonic bladder. Case 2 was in a 18-year-old woman consulted the urological department with a chief complaint of urinary retention accompanied with high fever, headache and vomiting. The spinal fluid examination and cystometry revealed aseptic meningitis and atonic bladder, respectively. In both cases, the patients were treated with conservative therapy and bladder dysfunction was resolved after a few weeks. Eleven cases of urinary retention secondary to aseptic meningitis have been reported in the previous literature.     

Urological complications following chemonucleolysis

Urinary complications following chemonucleolysis have not been reported in the urological literature. We report a case of urinary retention, perineal hypoesthesia and penile dysesthesia following L5 to S1 chemonucleolysis with chymopapain and review the literature in this area.     

Biofeedback in urology using urodynamics: preliminary observations.

Biofeedback training aided by urodynamic instrumentation produced significant clinical improvement in 4 of 8 urological patients. The display of electromyographic activity of the periurethral striated muscles was facilitated by the use of a new intraurethral catheter with 5 surface mounted electrodes. This modality of treatment seems worth considering for selected patients with urinary retention or urinary incontinence.     

Atresia hymenalis with acute urinary retention: a case report

We report a case of atresia hymenalis in a 14-year-old girl presenting with a clinical symptom of acute urinary retention. On physical examination she was found to have a lower abdominal mass and an imperforate bulging hymen. She underwent hymenal incision, and subsequently the symptom disappeared. It is very uncommon for atresia hymenalis to manifest itself with acute urinary retention as the first clinical sign, but we should consider this disease if a pubertal girl seeks medical opinion for acute urinary retention.     

Urinary retention without organic cause in children

Acute urinary retention without organic explanation is well known in adults but has only rarely been described in children. Six cases (four boys and two girls) of non-organic acute urinary retention are reported. The diagnosis was based on negative findings on extensive urological examination. So-called psychogenic urinary retention in children is associated with constipation and infrequent voiding.     

Neurofibroma of the bladder wall in von Recklinghausen''s disease

Neurofibromatosis, or von Recklinghausen's disease, is an autosomal dominant disease with multiple neurofibroma and café-au-lait spots. However, neurofibroma in the bladder wall is a rare condition in von Recklinghausen's disease. A 31-year-old man with neurogenic voiding dysfunction due to sacral meningocele and acute urinary retention with neurofibroma of the bladder wall is presented with detailed radiologic evaluation. Patients with von Recklinghausen's disease should be carefully evaluated if urological symptoms exist.     

Serum and urinary tissue polypeptide antigen (TPA) in patients with urological cancer

We measured the serum and urinary TPA in 64 patients with urological cancer, 55 patients with benign urological disease and 37 healthy volunteers. The serum TPA levels in patients with pre-treated cancer were significantly higher than those of healthy volunteers, but showed no significant difference compared to those in patients with a benign urological disease. The urinary TPA levels in patients with pre-treated cancer were significantly higher than those with a benign urological disease, but in some patients with urinary tract infection, very high urinary TPA concentrations were observed. Therefore, the determination of serum and urinary TPA may be useful in detecting urological cancer, but they were not specific tests. On the other hand, as lower serum and urinary TPA levels were observed after treatment of bladder and prostatic cancer, their determinations were considered to be useful in following up patients with these cancers.     

Urinary reconstruction in vertebral,anorectal, cardiac,trachea‐esophageal,renal abnormalities and limb defects association with chronic renal failure and penile duplication

Various urological complications in VATER association require careful management. A 15‐year‐old boy with VATER association, including a hypoplastic lower urinary tract and diphallia, presented with chronic kidney disease and incontinence after a right loop ureterostomy. In order to acquire urinary continence without renal function impairment, an ileocecal reservoir with umbilical catheterizable stoma was created as a urinary reconstruction. The ectopic posterior penis was resected for cosmetic reasons, and the stump of the hypoplastic urethra was opened at the perineal skin. Clean intermittent self‐catheterization through the umbilicus using disabled bilateral limbs was then achieved. This report describes the management of VATER association in a patient with complicated urological anomalies.     

A case of atresia hymen with urinary retention

A case of atresia hymen with urinary retention was reported. The patient was a 13-year-old female, who visited our clinic complaining of urinary retention and constipation. Examination of the external genitalia revealed atresia hymen . Intravenous pyelography showed hydronephrosis was not present. The symptoms disappeared completely after a hymenal incision was made. This case indicates necessity for caution concerning urological symptoms in females.     

Urological evaluation prior to renal transplantation

Renal transplantation is the best available therapy for patients with end-stage renal failure. Urologists are often consulted regarding pretransplant evaluation and treatment of potential renal transplant recipients. Frequently the urologist is the primary surgeon in the transplant unit. This review highlights the importance of performing a comprehensive urological assessment before renal transplantation. A retrospective review of the urological and transplant literature using Medline was performed from 1976 to 2002, searching for renal transplantation and its association with urological cancers and urinary tract malformations. The pretransplant urological assessment aims to diagnose, treat, and optimize any preexisting urological disease. On occasion, certain urological diseases may not be obvious or may not have contributed to the progression to end-stage renal failure such as occult urinary tract neoplasms, urinary calculus disease, or benign prostatic hyperplasia. A thorough evaluation of the urinary tract prior to renal transplantation is mandatory to avoid unforeseen problems occurring posttransplant. If this assessment is consistently adhered to, only in very rare circumstances does a potential recipient have to be denied the opportunity of receiving an allograft based on a preexisting urological disease.     

Selective urological evaluation in men with febrile urinary tract infection.

OBJECTIVE: To investigate the prevalence and clinical importance of urological abnormalities in men with community-acquired febrile urinary tract infection (UTI). PATIENTS AND METHODS: In this prospective study, 85 men (median age 63 years, range 18--86) were followed for 1 year after an episode of febrile UTI. They were investigated by excretory urography, cysto-urethroscopy, uroflowmetry, digital rectal examination and measurement of postvoid residual urine volume by abdominal ultrasonography. RESULTS: The radiological examination of the upper urinary tract in 83 patients revealed 22 abnormal findings in 19 men. Relevant clinical abnormalities leading to surgical intervention were found in only one patient who had renal calyceal stones. The lower urinary tract investigation disclosed 46 findings in 35 men. In all, surgically correctable disorders were found in 20 patients, of whom 15 had previously unrecognized abnormalities. All patients who required surgery were identified either by a history of voiding difficulties, acute urinary retention at the time of infection, the presence of microscopic haematuria at follow-up after one month, or early recurrent symptomatic UTI. CONCLUSION: Routine imaging studies of the upper urinary tract seem dispensable in men with febrile UTI. To reveal abnormalities of clinical importance, any urological evaluation should primarily be focused on the lower urinary tract.     

Management of voiding dysfunction associated with pelvic malignancies

Voiding dysfunction is common after surgical and radiation treatments in patients diagnosed with non‐urological pelvic malignancies. Presentation might vary with lower urinary tract symptoms and/or overactive bladder, urinary retention, or incontinence. We reviewed the most recent literature with the aim of describing various types of urinary dysfunction that manifest after radical treatments for non‐urological pelvic malignancies. Radical surgical or radiation treatment adversely affect other adjacent pelvic organ function, including viscera, pelvic musculature and the peripheral nervous system. This results in direct organ and indirect functional damage to the genitourinary tract. Multiple surgical and radiation modifications are available nowadays, allowing urologists to offer various treatments for better functional lower urinary tract outcomes. Diagnosing and understanding the type and severity of voiding dysfunction plays a key role in tailoring an appropriate treatment plan. The objective to better functional results relies on maintaining adequate bladder compliance and capacity while permitting volitional emptying, ideally through voiding. Management should routinely start with conservative measures, including pelvic floor muscle training with or without a combination of oral medication for urgency incontinence and clean intermittent catheterization for the management of urinary retention. Concomitant or isolated urinary incontinence can be further managed through multiple established surgical approaches. We attempted to address various treatment available for known lower urinary tract symptoms that might have been caused secondary to non‐urological pelvic surgery or radiation. We discuss different diagnostic and treatment modalities individualized for patients with various entities, to help achieve optimal urinary function and improve quality of life.     

Prevention of acute urinary retention following anorectal and perineal surgical procedures

One hundred forty patients underwent anorectal or perineal urological operative procedures. On completion of operation, 30 cc. of a 0.5 per cent aqueous solution of mercurochrome was instilled into the urinary bladder. Acute urinary retention requiring catheterization occurred in only one case (0.8 per cent). In a previous series of one hundred similarly operated cases in which no mercurochrome was used, acute urinary retention requiring catheterization occurred in fifty-seven.     

Urinary retention in females: A review

Female urinary retention is a common urological problem with many possible etiologies. Prior treatments attempted to decrease urethral resistance, but current neurourologic investigation has shown that this is rarely needed. Intermittent catheterization, along with diagnosing appropriate etiologic factors is the best management. If the workup reveals no organic etiology, psychological investigation may be needed because many of the patients have a significant psychosocial history. A multidisciplinary approach between the urologist, the psychiatrist and the neurologist usually provides the best management for females with urinary retention.     

Intramedullary epidermoid cyst presenting with abnormal urological manifestations

STUDY DESIGN: Report of an epidermoid cyst with intramedullary localization. OBJECTIVE: To describe an atypical presentation of intramedullary epidermoid cyst. SUMMARY OF BACKGROUND DATA: Intramedullary epidermoid cysts are rare entities with a marked variability in the clinical presentation, essentially of neurological pertinence. METHODS: Case report of a spinal epidermoid cyst in a 13-year-old girl presenting with urological symptoms: she had a 12-month history of recurrent low urinary tract infections, urinary frequency and nocturnal enuresis. A urodynamic evaluation was performed and showed the presence of involuntary bladder contractions with detrusor instability and low bladder compliance. Magnetic resonance imaging of the spine demonstrated an intramedullary lesion of the dorsal spinal cord. RESULTS: The mass was excised and 6 months after surgical excision, urological manifestations improved with decreased detrusor hyper-reflexia, increased bladder capacity and compliance and no later report of urinary tract infections. CONCLUSIONS: In our patient, unusual clinical manifestations of the tumor have delayed the diagnosis, but its complete removal has led to remission of symptoms. Detailed neurological examination and investigations are indicated in patients with clinical and urodynamic features, suggestive of neuropathic bladder.     

Two cases of congenital pelvic arteriovenous malformation in male

Congenital pelvic arteriovenous malformation(AVM) is extremely rare, especially in males. Herein we report two males with pelvic AVM. Computed tomography (CT) or magnetic resonance imaging (MRI) demonstrated markedly dilated, and tortuous vessels in the pelvis in both patients. The first patient, a 77- year-old male, presented with difficulty in voiding and weak urinary stream. He was scheduled to have a prostate biopsy for suspicion of prostate cancer with pelvic lymph node swelling. However, the mass was diagnosed as pelvic AVM with MRI, and the prostate biopsy was cancelled. He has been followed conservatively since then. The second patient, a 55-year-old male, presented with gross hematuria which caused severe hemorrhagic hypovolemic shock. He had pelvic AVM, and he was treated with transcatheter arterial embolization two times. When patients with this disease present with general urological symptoms, urological procedures, without attention to this disease, might cause severe complications such as serious hemorrhage. We discuss the clinical course and the treatment for AVM, and review the literature.     

Giant bladder diverticulum presenting with recurrent acute urinary retention--a rare event in adult patients: case report

Acquired giant bladder diverticula of obstructive genesis are not particularly unusual. On the other hand, acute urinary retention due to bladder diverticula is an extremely rare event in adult patients, since most cases are paediatric. A 40-year-old white male with a history of invasive urological procedures presented with recurrent acute urinary retention. Diagnostic procedures including cystourethrography and cystoscopy revealed a giant bladder diverticulum causing ab extrinseco compression of the urethra. The iatrogenic aetiology of the vicious circle of chronic urethral obstruction and increased luminal pressure promoting diverticular growth is discussed.     

Prevalence of Urinary Symptoms and Other Urological Conditions in Spanish Men 50 Years Old or Older

Purpose

We determined the prevalence of lower urinary tract symptoms and other urological conditions in Spanish men.

Materials and Methods

A cross-sectional population survey of 2,002 men 50 years old or older was done using interviewers in the autonomous community of Madrid. The main outcome measures were the self-reported International Prostate Symptom Score, and acute retention, incontinence, renal failure, hematuria, urinary infection and bladder stones.

Results

The estimated response rate among eligible responders was 68.1 percent. The prevalence of moderate or severe symptoms was 30.4 percent, which increased with age. Of men with moderate or severe symptoms 26.5 percent reported that the symptoms were a medium or great problem and 5.4 percent reported that the symptoms interfered with daily activities at least sometimes. The prevalence of other urological conditions related to the prostate was 5.1 percent for acute retention, 1.2 percent for current use of a catheter, 6.1 percent for incontinence, 2.4 percent for renal failure, 2.5 percent for hematuria, 5.2 for urinary infection and 0.7 percent for bladder stones.

Conclusions

The prevalence of moderate or severe symptoms is greater than reported in most other studies. Although Spanish men with moderate or severe symptoms report similar levels of bothersomeness, the impact of the symptoms in terms of interference with daily activities and perception of the future is less than that in other countries.