Intrinsic ureteric obstruction secondary to endometriosis: a rare clinical entity causing obstructive uropathy and renal failure.

Ureteral endometriosis is rare and can be a silent clinical entity, which can potentially lead to serious complications such as obstructive uropathy, sepsis and renal failure. A high clinical suspicion is required especially in childbearing age groups due to non-specific presentation such as renal colic, recurrent urinary tract infection (UTI), renal failure or asymptomatic hydronephrosis.A woman in her 40s presented with febrile UTI and flank pain. She reportedly suffered from recurrent UTIs in the past. Initial workup revealed an infected, obstructed left renal collecting system with gross hydronephrosis and hydroureter to the distal ureter on a significant gynaecological background of severe endometriosis requiring hysterectomy in the past.CT showed chronic obstructive changes and soft tissue nodules within the renal pelvis with no radio-opaque stones. She underwent emergent ureteric stent insertion. Functional imaging demonstrated only 1% contribution of the left kidney with a preserved estimated glomerular filtration rate of 65 mL/min/1.73 m2Endoscopic evaluation of ureters found extensive soft tissue lesions throughout the dilated left collecting system with biopsy-confirmed endometriosis. Subsequently, she underwent laparoscopic nephroureterectomy due to extensive ureteric involvement and chronically obstructed non-functioning kidney. Histopathology demonstrated completely obstructing ureteral endometriosis.Ureteric obstruction secondary to endometriosis can be due to extrinsic or intrinsic disease. In addition to initial assessment with CT urogram MRI may be helpful to evaluate soft tissue thickening. Endoscopic assessment with ureteroscopy and biopsy is required for tissue diagnosis. Surgery is often the treatment of choice, ranging from ureteroureterostomy, ureteroneocystostomy or nephroureterectomy in severe cases.Ureteral endometriosis is a rare clinical entity, clinicians should remain vigilant about common presentations of this rare entity, early diagnosis and prompt treatment is crucial to prevent progression to renal failure.

Melioidosis of the Female Genitourinary Tract.

Prostatic abscess is a common manifestation of melioidosis in men, but the characteristics of female genitourinary melioidosis are incompletely defined. There were 453 cases of melioidosis in Far North Queensland, tropical Australia, between January 1998 and April 2023; genitourinary involvement was less common in women than in men (13/140 [9%] versus 76/313 [24%], odds ratio [95% confidence interval]: 0.32 [0.17-0.60], P = 0.0004). In 11 of these 13 (85%) women, other organs were also affected. The two women with disease involving only the genitourinary tract had underlying anatomical abnormalities: one had an ovarian malignancy, the only case to involve the female reproductive system in the cohort, while the other had a urethral diverticulum. In 3 of 13 (23%) women, genitourinary involvement was identified only with computed tomography, emphasizing the importance of early imaging of patients with melioidosis to identify unexpected foci of disease and to inform the optimal duration of antibiotic therapy.

Does histological prostatic inflammation during transurethral resection of the prostate for bladder outlet obstruction affect post-operative urinary outcomes?

OBJECTIVE: Benign prostate hyperplasia (BPH) is a common cause for bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS) in men. The pathophysiology of BPH is multifactorial and inflammation has been linked with progression of BPH and LUTS. The association between histological prostatitis found at transurethral resection of the prostate (TURP) and adverse post-operative urinary outcomes is not clearly defined. Our aim was to evaluate the association between histological prostatitis and adverse post-operative urinary outcomes following TURP procedure. METHODS: Patients who had undergone TURP for BPH at a single institution between 2014 and 2018 were included. The study population was divided into three cohorts: those with no histological inflammation, those with any form of inflammation and those specifically with prostatic stromal inflammation. Functional outcomes were assessed by defining a series of measurable post-operative "LUTS events" and comparing these to time-to-event profile using a Kaplan-Meier estimator. RESULTS: A total 198 patients were included (no inflammation n = 101; any inflammation n = 97, prostatic stromal inflammation n = 81). All three groups were comparable in terms of baseline characteristics. The any inflammation group had significantly more adverse post-operative outcomes after TURP compared to the no inflammation group, P = 0.0065. The stromal inflammation group had more LUTS events after surgery compared to the no inflammation groups in the first year of follow-up n = 0.011; over a 5-year follow-up period the results were not statistically significant, P = 0.244. CONCLUSION: Histological prostatitis is associated with worse urinary outcomes after TURP compared to no inflammation. These results are useful in improving prognostic discussions with patients after TURP.

Idiopathic spontaneous rupture of the urinary bladder: An unusual presentation of intraperitoneal bladder rupture managed conservatively.

Spontaneous rupture of the urinary bladder (SRUB) is uncommon and associated with significant morbidity and mortality. We report an unusual presentation of idiopathic, spontaneous bladder rupture with normal ascitic fluid creatinine concentration. SRUB should be considered in patients with a rise in serum creatinine and intraperitoneal free fluid even in the absence of classical features of bladder rupture. Idiopathic intraperitoneal SRUB can be conservatively managed in carefully selected patients with close follow up.

Prediction of pathological stage at radical prostatectomy: do commonly used prostate cancer nomograms apply to men from Far North Queensland?

BACKGROUND: Clinical nomograms are routinely used by urologists to predict pathological and clinical outcomes. Commonly used prostate cancer nomograms include Partin's tables and Memorial Sloan Kettering Cancer Centre (MSKCC) nomograms which were developed in high-volume centres in the United States. We aimed to assess whether these tools are valid for prostate cancer patients in Far North Queensland. METHODS: All patients undergoing radical prostatectomy in Cairns between August 2014 and September 2017 were identified. Preoperative data were entered into the online nomogram tools. The predicted probability of organ-confined (OC) disease, extra-prostatic extension (EPE) and seminal vesical invasion was compared to the observed outcomes. RESULTS: Preoperative clinical information was available for 290 patients. Partin's tables accurately estimated OC disease, EPE and seminal vesical invasion with the observed outcome plot overlying the ideal correlation curve. More patients in our cohort had OC disease than was predicted by the MSKCC nomogram; fewer patients had EPE that was predicted by the MSKCC nomogram. On logistic regression modelling, the area under the curve for MSKCC and Partin's were 0.751 and 0.706, respectively, suggesting both tests have good performance in predicting final pathological outcome for our population of patients with no statistical difference between the two nomograms (P = 0.29). CONCLUSION: The MSKCC preoperative nomogram and Partin's tables were both able to accurately predict pathological outcomes from preoperative clinical information in men from Far North Queensland, despite likely differences in population genetics and environmental exposures.

Prostatic Abscess due to Burkholderia pseudomallei: Facilitating Diagnosis to Optimize Management.

Prostatic involvement is common in men with melioidosis. Indeed, some clinicians recommend radiological screening of all male patients as an undrained prostatic abscess may result in relapse of this potentially fatal disease. However, sophisticated medical imaging is frequently unavailable in the remote and resource-poor locations where patients are managed. In this retrospective study from Queensland, Australia, 22/144 (15%) men with melioidosis had a radiologically confirmed prostatic abscess. The absence of urinary symptoms had a negative predictive value (NPV) (95% confidence interval [CI]) for prostatic abscess of 96% (90-99%), whereas a urinary leukocyte count of < 50 × 106/L had an NPV (95% CI) of 100% (94-100%). A simple clinical history and basic laboratory investigations appear to exclude significant prostatic involvement relatively reliably and might be used to identify patients in whom radiological evaluation of the prostate is unnecessary. This may be particularly helpful in locations where radiological support is limited.

Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: a UK national audit.

OBJECTIVES: To evaluate the use of post-discharge venous thromboembolism (VTE) prophylaxis in UK pelvic cancer centres consistent with national guidelines. METHODS: Data was collected from healthcare professionals from 64 UK pelvic cancer centres. RESULTS: After radical cystectomy (RC), all cancer centres routinely use low-molecular-weight heparin (LMWH) in the perioperative period. After RC 67% of cancer centres use post-discharge LMWH routinely. After radical prostatectomy (RP), 98% of units use perioperative LMWH VTE prophylaxis routinely. After RP, 61% of hospitals always use post-discharge LMWH. In all, 27% of all UK cancer centres reported deaths or serious VTE complications from urological pelvic cancer surgery in the last 2 years. CONCLUSIONS: The National Institute for Health and Care Excellence (NICE) issued explicit guidance of VTE prophylaxis after pelvic and abdominal cancer surgery. Conversion of national guidance into local policy is ≈60% for UK pelvic cancer centres. A lack of good quality evidence is cited as a reason for not adhering to NICE guidance.

Lower limb compartment syndrome as a complication of robot-assisted radical prostatectomy: the UK experience.

OBJECTIVE: To evaluate the incidence of lower limb compartment syndrome (LLCS) in robot-assisted radical prostatectomy (RARP) and the prevalence of risk factors in patients with LLCS. METHODS: Data were collected from 17 UK robotic surgery institutions for a multicentre analysis. Data were used to calculate the incidence of LLCS and the prevalence of risk factors. RESULTS: A total of 3110 RARPs were performed by 17 institutions between 2004 and 2011. There were nine cases of LLCS, giving an incidence of 0.29%. Seven of these required fasciotomy. The prevalence of risk factors was as follows: console time >4 h in 8/9 cases, early learning curve (<20 cases) in 3/9 cases; obesity (BMI >30 kg/m(2) ) in 5/9 cases; and peripheral vascular disease in 2/9 cases. One patient with LLCS was positioned incorrectly. CONCLUSIONS: The serious complication LLCS occurs in RARP but has a low incidence. Long operating times, surgical inexperience, poor patient positioning, obesity and vascular disease appear to be risk factors.

Clinical presentations of schistosoma hematobium: three case reports and review.

Urinary schistosomiasis is a prevalent parasitic infection in certain areas of Africa and the Middle East. It could present with common as well as unusual urological symptoms, which poses a considerable diagnostic challenge in countries where there is relative low incidence of the disease. We describe three unusual cases of urinary schistosomiasis identified in patients presenting to a London hospital. One patient was found to have schistosomiasis in the seminal vesicles following surgery for prostatic adenocarcinoma. Another was found to have schistosoma-related granulomatous inflammation within a urachal cyst. Thirdly a patient was found to have simultaneous occurrence of transitional cell carcinoma and schistosomiasis of the bladder. We review the literature on the presentations of the parasite and its association with malignancy. In conclusion, awareness of the disease prevalence, clinical and histopathological features will help to avoid missing the diagnosis.

NAD(P)H:quinone oxidoreductase 1 and nrh:quinone oxidoreductase 2 activity and expression in bladder and ovarian cancer and lower NRH:quinone oxidoreductase 2 activity associated with an NQO2 exon 3 single-nucleotide polymorphism.

PURPOSE: NRH:quinone oxidoreductase 2 (NQO2) is a homologue of NAD(P)H:quinone oxidoreductase 1 (NQO1). Despite 54% homology with human NQO1, NQO2 has little endogenous enzymatic activity. However, NQO2 has potential as a therapeutic target because the addition of the nonbiogenic electron donor dihydronicotinamide riboside (NRH) selectively potentiates the bioactivation of the alkylating agent tretazicar (CB 1954). The NQO activity of ovarian and bladder tumors was determined and the effect of NQO polymorphisms on NQO activity was investigated. EXPERIMENTAL DESIGN: Intraperitoneal ovarian metastases and bladder tumor clinical samples were analyzed for NQO1 and NQO2 activity, mRNA expression by semiquantitative reverse transcription-PCR, and genotype by RFLP analysis. RESULTS: NQO1 activity was higher in the bladder cohort than in the ovarian cohort (0-283 and 0-30 nmol/min/mg, respectively; P < 0.0001). In contrast, NQO2 activity was higher in the ovarian tissue than in the bladder samples (0.15-2.27 and 0-1.14 nmol/min/mg, respectively; P = 0.0004). In both cohorts, the NQO1 C609T single-nucleotide polymorphism (SNP) was associated with approximately 7-fold lower NQO1 activity. The NQO2 exon 3 T14055C SNP was associated with lower NQO2 activity relative to wild-type [median values of 0.18 and 0.37 nmol/min/mg in the bladder samples (P = 0.007) and 0.82 and 1.16 nmol/min/mg in the ovarian cohort (P = 0.034)]. CONCLUSION: This is the first observation reporting an apparent association between an NQO2 exon 3 SNP and lower enzymatic activity. The high NQO2 activity of intraperitoneal ovarian metastases relative to other tissues indicates a potential for tretazicar therapy in the treatment of this disease. In contrast, the low level of NQO1 activity and expression relative to other tissues suggests that NQO1-directed therapies would not be appropriate.

Clinical evaluation of a simple uroflowmeter for categorization of maximum urinary flow rate.

OBJECTIVE: To evaluate the accuracy and diagnostic usefulness of a disposable flowmeter consisting of a plastic funnel with a spout divided into three chambers. MATERIALS AND METHODS: Men with lower urinary tract symptoms (LUTS) voided sequentially into a standard flowmeter and the funnel device recording maximum flow rate (Q(max)) and voided volume (V(void)). The device was precalibrated such that filling of the bottom, middle and top chambers categorized maximum input flows as <10, 10-15 and > 15 ml s(-1) respectively. Subjects who agreed to use the funnel device at home obtained readings of flow category and V(void) twice daily for seven days. RESULTS: A single office reading in 46 men using the device showed good agreement with standard measurement of Q(max) for V(void) > 150 ml (Kappa = 0.68). All 14 men whose void reached the top chamber had standard Q(max) > 15 ml s(-1) (PPV = 100%, NPV = 72%) whilst eight of 12 men whose void remained in the bottom chamber had standard Q(max) < 10 ml s(-1) (PPV = 70%, NPV = 94%). During multiple home use by 14 men the device showed moderate repeatability (Kappa = 0.58) and correctly categorized Q(max) in comparison to standard measurement for 12 (87%) men. CONCLUSIONS: This study suggests that the device has sufficient accuracy and reliability for initial flow rate assessment in men with LUTS. The device can provide a single measurement or alternatively multiple home measurements to categorize men with Q(max) < 15 ml s(-1).