Ureterolithiasis after Cohen re-implantation--case report.
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BACKGROUND: In the past decades, the widespread use of cross-trigonal ureteral reimplants for the treatment of children with vesicoureteral reflux has resulted in a large population of patients with transversely lying ureters. As this population gets older they will consequently be entering an age group at higher risk for stone and urothelial cancer formation. If ureteroscopy becomes necessary, the transverse position of the ureter makes ureteric access often impossible. CASE PRESENTATION: We present the case of a young man who not only suffered from urolithiasis due to hyperparathyroidism, but also further jeopardized his treatment by omitting the fact that as a child he underwent Cohen reimplantation of the right ureter. CONCLUSIONS: This case illustrates the particular difficulties the endoscopist may face in this group of patients. Patients with difficult ureteric access, abnormal anatomy, or those with known cross-trigonal ureteric reimplantations should be managed in a specialised endourology unit. (+info)
Prenatal mild pyelectasis: evaluating the thresholds of renal pelvic diameter associated with normal postnatal renal function.
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OBJECTIVE: To determine the threshold of the renal pelvic anteroposterior (AP) diameter that predicts normal postnatal renal outcome in the follow-up of cases with mild pyelectasis. METHODS: A retrospective review of our sonography database was conducted over a 3-year period for cases of mild pyelectasis diagnosed between 18 and 30 weeks. Cases were evaluated for the association between different thresholds of renal pelvic anteroposterior diameter and normal postnatal function after 32 weeks' gestation and also for the initial renalpelvic anteroposterior diameter at 18 to 30 weeks. RESULTS: In the 3-year period, 7416 women were evaluated, and 150 cases with a diagnosis of pyelectasis (2%) were identified. Among the 115 women meeting our inclusion criteria, complete outcomes were available for 66. Persistent postnatal renal anomalies were seen in 20 cases (30%). On the basis of receiver operating characteristic curves, the renal threshold that best predicted normal postnatal outcome was an anteroposterior diameter of less than 7.0 mm after 32 weeks, yielding sensitivity and specificity of 87% and 85%, respectively (odds ratio, 0.31; 95% confidence interval, 0.11-0.86; P < .02). CONCLUSIONS: In the follow-up of fetuses with a diagnosis of mild pyelectasis between 18 and 30 weeks, a renal pelvic anteroposterior diameter of less than 7.0 mm after 32 weeks is highly predictive of normal postnatal renal function. Therefore, only those with an anteroposterior diameter of greater than 6 mm after 32 weeks deserve follow-up. (+info)
Anaplastic lymphoma kinase (ALK 1) staining and molecular analysis in inflammatory myofibroblastic tumours of the bladder: a preliminary clinicopathological study of nine cases and review of the literature.
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Inflammatory myofibroblastic tumours (IMFT) may arise at any anatomical site, including lung, soft tissues, retroperitoneum and bladder. Although morphologically similar, these lesions encompass a spectrum of entities with differing aetiology, ranging from reactive/regenerative proliferations to low-grade neoplasms with a risk of local recurrence, but no significant metastatic potential. Vesical IMFT usually presents as a polypoid mass with a pale firm cut surface and can be of considerable size, mimicking a malignant tumour clinically and radiologically. Its good outcome, however, warrants conservative surgical excision, emphasising the importance of identification and distinction from malignant tumours of the bladder that may require more radical surgery and/or adjuvant therapy. We conducted a preliminary retrospective, comparative immunocytochemical study of 20 bladder tumours, including nine IMFTs, five spindle cell (sarcomatoid) carcinomas, two rhabdomyosarcomas, two leiomyosarcomas and two neurofibromas. The results confirmed IMFT positivity for smooth muscle actin, desmin and cytokeratin in 78-89% cases, resulting in potential confusion with sarcomatoid carcinoma or leiomyosarcoma. In contrast, cytoplasmic anaplastic lymphoma kinase (ALK 1) staining was present in eight IMFT (89%), but was not seen in any other lesion examined. The ALK 1 staining was confirmed by fluorescence in situ hybridisation, with translocation of the ALK gene present in 15-60% tumour cells in four of six IMFT examined, but not in four cases of sarcomatoid carcinoma or three of leiomyosarcoma. In conclusion, ALK 1 staining may be of value in the distinction of vesical IMFT from morphologically similar entities, and often reflects ALK gene translocations in these lesions. (+info)
Deep vein thrombosis associated with distension of the urinary bladder due to benign prostatic hypertrophy--a case report.
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A 76-year-old man was admitted with a first episode of deep vein thrombosis (DVT) of his left leg. It was associated with a distended urinary bladder, due to benign prostatic hypertrophy. Screening for malignancy was negative. Laboratory testing revealed protein S deficiency. Although a distended bladder may induce venous stasis, it is not a proven risk factor for DVT. Clinical expression possibly depends on the concomitance of other risk factors, such as inherited or acquired thrombophilic defects. However, it is also possible that the association of a distended bladder with DVT of a lower limb has not been recognised yet. As a distended bladder is rather common in elderly men, a proper study is warranted to estimate the prevalence of associated DVT. (+info)
Catastrophic secondary antiphospholipid syndrome with peripheral nervous system involvement: a case report.
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A 34-year-old woman was admitted to our emergency room with a high fever, abdominal pain, dyspnea and confusion. High fever and abdominal pain had first occured after a cystocele operation 5 months earlier. Later, congestive heart failure with mural thrombus formation, peripheral polyneuropathy and ischemic cerebrovascular accident were identified in clinical follow-ups, and multiple arterial and venous thromboses were seen on cranial and abdominal magnetic resonance imaging angiography. The patient's symptoms improved with anticoagulant treatment. Antiphospholipid syndrome with elevated serum anticardiolipin IgG levels was diagnosed, and ischemic peripheral polyneuropathy with axonal degeneration was determined by sural nerve biopsy. In antiphospholipid syndrome, elevated anticardiolipin antibodies appear to be the most common acquired blood protein defect causing thrombosis. Disseminated vascular thrombosis in catastrophic antiphospholipid syndrome can result in multiorgan failure with increased morbidity and mortality. It rarely occurs secondary to various infections as in the case of our patient, who suffered postoperative intraabdominal infection. It is important to note that peripheral nervous system involvement is rare in antiphospholipid syndrome. (+info)
Verrucous carcinoma of the bladder with koilocytosis unassociated with vesical schistosomiasis.
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CONTEXT: Verrucous carcinoma of the bladder is a very rare malignant neoplasm, histologically similar to condyloma acuminatum. Usually it shows association with vesical schistosomiasis (bilharziasis). Only 13 cases unrelated to bilharziasis have been reported to date, and none of them reported koilocytosis, a typical finding in human papillomavirus infection. CASE REPORT: We report a case of verrucous carcinoma of the bladder that was unrelated to bilharziasis, with koilocytosis and absence of human papillomavirus. The literature relating to the topic is discussed. (+info)
Urinary bladder contraction and relaxation: physiology and pathophysiology.
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The detrusor smooth muscle is the main muscle component of the urinary bladder wall. Its ability to contract over a large length interval and to relax determines the bladder function during filling and micturition. These processes are regulated by several external nervous and hormonal control systems, and the detrusor contains multiple receptors and signaling pathways. Functional changes of the detrusor can be found in several clinically important conditions, e.g., lower urinary tract symptoms (LUTS) and bladder outlet obstruction. The aim of this review is to summarize and synthesize basic information and recent advances in the understanding of the properties of the detrusor smooth muscle, its contractile system, cellular signaling, membrane properties, and cellular receptors. Alterations in these systems in pathological conditions of the bladder wall are described, and some areas for future research are suggested. (+info)
An antiproliferative factor from interstitial cystitis patients is a frizzled 8 protein-related sialoglycopeptide.
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Approximately 1 million people in the United States suffer from interstitial cystitis, a chronic painful urinary bladder disorder characterized by thinning or ulceration of the bladder epithelial lining; its etiology is unknown. We have identified a glycosylated frizzled-related peptide inhibitor of cell proliferation that is secreted specifically by bladder epithelial cells from patients with this disorder. This antiproliferative factor (APF) profoundly inhibits bladder cell proliferation by means of regulation of cell adhesion protein and growth factor production. The structure of APF was deduced by using ion trap mass spectrometry (MS), enzymatic digestion, lectin affinity chromatography, and total synthesis, and confirmed by coelution of native and synthetic APF derivatives on microcapillary reversed-phase liquid chromatography (microRPLC)/MS. APF was determined to be an acidic, heat-stable sialoglycopeptide whose peptide chain has 100% homology to the putative sixth transmembrane domain of frizzled 8. Both synthetic and native APF had identical biological activity in normal bladder epithelial cells and T24 bladder cancer cells. Northern blot analysis indicated binding of a probe containing the sequence for the frizzled 8 segment with mRNA extracted from cells of patients with interstitial cystitis but not controls. APF is therefore a frizzled-related peptide growth inhibitor shown to contain exclusively a transmembrane segment of a frizzled protein and is a potential biomarker for interstitial cystitis. (+info)