Self-Inserted Knotted Wire Through the Urethra: A Case Report.

Foreign bodies in the lower urinary system are relatively uncommon. The foreign body can cause significant discomfort, hematuria, or infection of the urinary system. Diagnosis is usually made by clinical examination and pelvic X-ray. The case we present is interesting in that the foreign body, that is the wire, coiled and made a knot within the bladder. We report a case of a 25-year-old male who presented with a history of dysuria after the insertion of a foreign body into the urethra. Examination showed a wire protruding from the urethra with no bleeding or discharge. X-ray showed a wire from the meatus, coiled and tied in the bladder. Open cystostomy and extraction of the wire were done successfully. Foreign bodies are usually a result of psychological illness. Thereby, psychiatric evaluation is needed in such a presentation. Management should be started by a trial of retrieval or, if failed, endoscopically or by open cystostomy.

Ketamine Impact on Kidney Health.

Ketamine-induced uropathy (KIU) is a serious consequence of chronic ketamine abuse, presenting with complex renal and urinary symptoms. This study describes a 34-year-old female with a history of chronic ketamine abuse, resulting in stage 3 chronic kidney disease (CKD) and severe urological complications. Despite discontinuing ketamine use five years ago, she remains dependent on ureteral stents due to recurrent hydronephrosis and ureteral obstruction. The patient began using ketamine at the age of 25 years, consuming approximately 5 g daily for two years. By the age of 27 years, she developed dysuria, flank pain, and burning micturition and was later diagnosed with ketamine-associated cystitis and renal failure secondary to hydronephrosis. Initially, bilateral ureteral stents were placed to manage her condition, but she continued to experience worsening symptoms. Although studies suggest that early cessation of ketamine can resolve ulcerative cystitis and ureteral obstruction, this was not observed in our patient. This case highlights the importance of high suspicion for ketamine abuse in young patients presenting with ureteral complications such as hydronephrosis and cystitis-like symptoms. It highlights the need for early detection, ongoing follow-up, and a comprehensive approach involving pharmacological and surgical interventions. Effective management also requires counseling on ketamine discontinuation to prevent further and permanent damage to the urinary system.

[A 49-year-old woman with long-standing urinary symptoms. Histological and immunohistochemical study of a case of bladder mullerianosis]. / Mujer de 49 años con clínica urinaria de larga evolución. Estudio histológico e inmunohistoquímico de un caso de mullerianosis vesical.

Bladder müllerianosis is defined by the presence of Müllerian epithelium (endometrial, endocervical or endosalpinx) in the bladder. It is a rare benign disease that affects women and presents a non-specific clinical presentation that poses a broad differential diagnosis. We present the case of a 49-year-old woman who presented with recurrent urinary tract infections, urinary discomfort and abdominal pain. The approach is carried out by ultrasound and urethrocystoscopy that reveal the presence of a 5mm polypoid lesion that is removed. The histological study revealed bladder müllerianosis together with the complementary finding of glandular cystitis and cystic cystitis.

Urethral keratosis caused by vitamin A deficiency: two case reports.

BACKGROUND: Dysuria in children can have various etiologies, including ureteric stones, phimosis, congenital obstructive posterior urethral membrane, and neurogenic bladders. However, there have been no reports of vitamin A deficiency (VAD) causing dysuria due to urethral keratosis. Here, we report two cases of urethral keratosis caused by a VAD. CASE PRESENTATION: An 8-year-old boy (Patient 1) and a 6-year-old boy (Patient 2) presented with multiple episodes of dysuria and epididymitis. Both patients had intellectual disabilities and autism, which prevented voiding cystourethrography. Therefore, the patient was admitted for cystoscopy under general anesthesia. Cystoscopy revealed urethral diastolic dysfunction and a large amount of desquamated epithelium obstructing the urethra in both patients, causing urinary obstruction and dysuria. Catheterization was repeated; however, the symptoms recurred after catheter removal. Although the cause of recurrent urinary obstruction could not be initially identified, an ophthalmologist found Bitot's spots and suggested the possibility of a VAD. Serum vitamin A levels were extremely low in both patients, leading to the diagnosis of urethral keratosis due to VAD. VAD can be attributed to an unbalanced diet resulting from intellectual disabilities or autism. Vitamin A replacement therapy improved both the urethral symptoms and cystoscopic findings. CONCLUSION: Dysuria due to VAD is extremely rare, and urethral keratosis as a cause of dysuria is likely the first report of its kind worldwide. VAD may develop due to an unbalanced diet in patients with intellectual disabilities or autism. Therefore, it is essential to consider VAD as a potential cause of dysuria in patients with intellectual disabilities and autism.

Predictive Factors for the Successful Outcome of Urethral Sphincter Injections of Botulinum Toxin A for Non-Neurogenic Dysfunctional Voiding in Women.

PURPOSE: Dysfunctional voiding (DV) is not uncommon in women with non-neurogenic voiding dysfunction. Because of its unknown pathophysiology, effective and durable treatment is lacking. This study aimed to analyze the results of treatment and predictive factors for a successful outcome of botulinum toxin A (BoNT-A) treatment in female patients with DV. METHODS: In total, 66 women with DV confirmed by a videourodynamic study (VUDS) were treated with a BoNT-A injection into the urethral sphincter once (n = 33) or several times (n = 33). VUDS was performed before (baseline) and after the BoNT-A treatment. Patients with a global response assessment of the voiding condition of 2 or 3 and a voiding efficiency (VE) of >20% than baseline were considered to have a successful outcome. The baseline demographics, VUDS parameters, and VUDS DV subtypes were compared between the successful and failed groups. Predictive factors for a successful outcome were investigated by logistic regression analyses. RESULTS: Successful and failed outcomes were achieved in 27 (40.9%) and 39 (59.1%) women, respectively. After BoNT-A injections, the maximum flow rate (Qmax), voided volume, and VE all significantly increased, and the postvoid residual (PVR) was slightly improved. No significant difference in the number of injections and medical comorbidity was found between the groups. However, the successful group had a higher incidence of previous pelvic surgery. No significant difference in the treatment outcome was found among patients with different urethral obstruction sites. Significant improvements in Qmax, voided volume, PVR, VE, and the bladder outlet obstruction (BOO) index were noted in the successful group. A lower VE at baseline and a history of surgery were identified as predictive factors for a successful outcome of BoNT-A injections for treating DV. CONCLUSION: BoNT-A injections into the urethral sphincter can effectively improve VE in 40.9% of women with DV. Women with higher BOO grades and previous pelvic surgery are predicted to have a successful treatment outcome.

Treatment of a urethral stricture by image-guided placement of a custom-made absorbable stent in a standing, sedated horse.

A 10-year-old Irish Sport Horse gelding developed complications from a general anesthesia resulting in sling support and recurrent urinary catheterization. The horse subsequently presented signs of dysuria and pollakiuria, was diagnosed with sabulous cystitis, and developed a urethral stricture from the repeated catheterizations, which was confirmed on urethroscopy. Clinical signs persisted despite conservative management with topical corticosteroids and urethral bougienage with balloon dilators. An image-guided approach was used to treat the stricture with a custom-made polydioxanone stent placed in the urethra after which the horse was able to void normally and fully empty his bladder. Repeat urethroscopy and ultrasonography 6 months after the procedure showed the stent to have completely reabsorbed with urethra remaining patent. Nineten months after the procedure, the owner reports the horse remaining at his intended level of athletic performance with no dysuria.

Dysuria and Vaginal Pain, Unusual Manifestations of B-acute Lymphoblastic Lymphoma.

Urinary symptoms are one of the most common reasons for emergency visits in females of pediatric age group and can be associated with various conditions like infections (most common), sexual trauma and rarely neoplastic processes. Here, we report a case of a 7-year-old female who presented in the emergency multiple times with the complaints of urinary symptoms and vaginal pain and was empirically treated with antibiotics and antifungals without symptomatic improvement. Her blood tests, physical examination during this time remained unrevealing. She was then transferred to our institution on her third emergency visit for further evaluation. On imaging studies, she was noted to have expansile lesions on her vertebral body at the L4 and T6 levels with compressive myelopathy with multiple bone and soft tissue lesions throughout her lower extremities. Patient developed saddle anesthesia requiring emergent decompression and biopsy of the epidural mass with the final pathology coming back as B-lymphoblastic leukemia/lymphoma. B-ALL/B-LBL is the most common pediatric hematologic malignancy and usually presents with fever, hepatosplenomegaly, lymphadenopathy, bone pain and bleeding. Occasionally, atypical presentations like bone and joint pain, osteoporosis, palpable paravertebral mass have been described. However, this is the first case report to describe a very unusual and unfamiliar presentation of this disease causing significant diagnostic difficulty resulting in delayed treatment. This case report can aid as a reminder that unusual pain or any nonspecific manifestations in pediatric patients, refractory to common treatment should be investigated with extreme diligence not to miss this neoplastic process.

A Self-Induced Foreign Body in the Urinary Bladder of an Adolescent Female.

In the pediatric population, foreign bodies within the urinary bladder are uncommon, typically resulting from urethral insertion out of curiosity. Other etiologies include sexual assault, iatrogenic factors, or migration from adjacent sites. Symptoms such as urinary retention, dysuria, increased frequency, decreased volume, nocturia, hematuria, painful erections, and pelvic pain are common. Radiographic imaging in the form of pelvic X-rays, ultrasound and CT scans often aids in diagnosis and making an action plan. Management depends on the object type, size, location and available expertise, often starting with a transurethral approach and resorting to open surgery if necessary. This case report describes a 13-year-old female presenting with severe dysuria and visible hematuria. Initially reporting the accidental insertion of a scarf pin into her vagina, she later admitted to intentionally inserting it. A pelvic radiograph revealed a needle-like object in the pelvis but its location and position were more convincing of its presence in the urinary bladder. A diagnostic cystoscopy was performed which confirmed a scarf pin in the urinary bladder, embedded in its wall. The pin was successfully removed transurethrally using endoscopic forceps.

The Efficacy of CO2 Vaginal Laser in the Treatment of Recurrent, Post-Coital and Interstitial Cystitis: A Multicentric Prospective Study.

Background: This multicentric prospective study was carried out at Fondazione Policlinico Universitario Campus Bio Medico and Ospedale di Stato of St. Marino Republic. Between 1 January 2019, and 31 December 2022, all pre- and post-menopausal women diagnosed with recurrent, post-coital, and interstitial cystitis at both centers were included in the study. The main aim of the study was to assess the effectiveness of vaginal CO2 laser treatment, alone or combined with intravesical hyaluronic acid instillations, in managing cystitis symptoms, such as dysuria, pollakiuria, and urgency, across the entire patient cohort. The secondary objective was to investigate the reduction in number of annual cystitis episodes post-treatment. Methods: Each woman underwent three to four sessions of micro-ablative CO2 vaginal laser treatment. A follow-up examination was conducted 12 months after the final laser session (up to December 2023), during which a post-treatment VAS assessment evaluated dysuria, daily pollakiuria, and urgency. The enrolled patients recorded the number of cystitis episodes experienced during the 12-month pre- and post-treatment period. Results: Results indicated the laser's efficacy in reducing the total number of cystitis episodes per year and an improvement in symptoms up to one year post-treatment. Greater efficacy of the CO2 laser treatment, particularly when combined with intravesical hyaluronic acid instillation, was observed in both pre- and post- menopausal women. Conclusions: Fractional CO2 laser therapy represents a safe and efficacious, non-hormonal approach for pre- and post-menopausal women diagnosed with recurrent, post-coital, and interstitial cystitis.

Eosinophilic cystitis mimicking bladder tumor: A case report.

Eosinophilic cystitis (EC) is a rare inflammatory condition characterized by eosinophilic infiltration into the bladder wall. It often presents symptoms common to urological issues such as urinary tract infections, hematuria, bladder stones, or bladder neoplasms. Here, we describe a case of a 44-year-old male veteran with a history of multiple tuberculosis episodes who presented to the Emergency Department with dysuria, suprapubic pain, and gross hematuria. Initial imaging and cystoscopy concerned bladder neoplasia; however, subsequent pathological evaluation showed EC. This case underscores the importance of considering EC in the differential diagnosis of bladder tumors, especially when imaging describes bladder wall thickening in a patient without risk factors for bladder malignancy.

Prostatic stromal tumor of uncertain malignant potential: a case report and literature review.

Prostatic stromal tumors, encompassing prostatic sarcoma and stromal tumors of uncertain malignant potential (STUMP), represent an exceedingly rare category of prostatic diseases, with a prevalence of less than 1%. We present a rare case involving a man in his early 40s diagnosed with STUMP. Despite presenting with normal prostate-specific antigen (PSA) concentrations, the patient experienced persistent dysuria and gross hematuria for >7 months, leading to an initial misdiagnosis of benign prostatic hyperplasia. Persistent symptoms prompted further investigation, with magnetic resonance imaging (MRI) revealing a suspicious lesion on the left side of the prostate, initially thought to be malignant. Transrectal prostatic biopsy subsequently confirmed the presence of mucinous liposarcoma, with no medical history of diabetes, coronary heart disease, or hypertension. The treatment approach comprised robot-assisted laparoscopic radical prostatectomy, culminating in a postoperative pathological definitive diagnosis of STUMP. This case underscores the indispensable role of early MRI in the diagnostic process, highlighting the necessity of detailed pathological examination for a conclusive diagnosis. Our report aims to illuminate the diagnostic challenges and potential treatment pathways for STUMP, emphasizing its consideration in the differential diagnosis of prostatic tumors to advance clinical outcomes in this rare but important condition.

[The urological case reports of the Hippocratic Corpus : Medical practice in classical Greece]. / Die urologischen Fallberichte des Corpus Hippocraticum : Medizinische Praxis im klassischen Griechenland.

OBJECTIVE: Which theoretical and practical competences do the urologic case histories of the Hippocratic Corpus convey? MATERIALS AND METHODS: The 431 Hippocratic case histories have been studied for reports and communication on diagnostic methods, treatment, and prognosis related to urologic diseases. RESULTS: Within the seven books of the Hippocratic Epidemics, a total of 69 patients with urologic symptoms are described; in 21 cases the urologic disease is dominant. The leading clinical signs were urine discoloration and urinary sediment, polyuria, testicular swelling and pain, hematuria, stranguria, anuria, and renal pain, the most frequent diseases were nephritis and urolithiasis. Most patients were men in juvenile and adult age; 33 sick persons are named. The statements of patients regarding the course of their illness were often sparse. Diagnostic tests were restricted to inspection and palpation. Otherwise, treatment was confined to conservative measures. The dietary decisions for treatment of nephritis were differentiated but nonuniform. CONCLUSION: The Hippocratic physician diagnosed and treated diseases of the urinary tract. Inflammatory conditions and traumatic lesions are described in detail. Highest priority was awarded to uroscopy. Nephritis was a widespread disorder und usually associated with other symptoms, above all fever. The urinary tract was often regarded as an indicator of physical and mental health. Conservative treatment measures dominate in the case reports.

Spindle cell embryonal rhabdomyosarcoma of the prostate in an adult patient: a case report and review of the literature.

Rhabdomyosarcoma of the prostate is a rare mesenchymal tumor that originates from undifferentiated mesenchymal cells. Spindle cell rhabdomyosarcoma is a variant of embryonal rhabdomyosarcoma. The vast majority of these two pathological types occur in children, with only a few adult cases reported to date, and both are associated with poor clinical outcomes. We herein report a case involving a man in his early 40s with spindle cell embryonal rhabdomyosarcoma of the prostate. His chief complaint was difficult urination. The diagnosis was confirmed by puncture biopsy of the prostate, and pelvic lymph node metastasis was already present at the time of diagnosis. The patient underwent three courses of chemotherapy. However, his response to the treatment was very poor, and he died of the disease 4 months after diagnosis.

Foreign Body in the Male Urinary Bladder: A Case Report.

A foreign body in the urinary bladder is an uncommon finding in urology emergencies. There are several ways in which intravesical foreign bodies can occur, including iatrogenic injuries, self-insertion for pleasure, sexual abuse, assault, and migration from adjacent sites. This case report is about an interesting presentation of a 36-year-old male who presented to the urology outpatient department with a burning sensation and dribbling while urinating for 1 month. An X-ray of the pelvis revealed multiple radiodensities (morphology was suggested as magnetic balls) in the pelvic soft tissues. Cystoscopy was performed and three-pronged forceps were utilized to remove the magnetic foreign bodies. The patient had an insignificant hospital course and was discharged with analgesics and antibiotics.

Leiomyosarcoma of the prostate: a novel approach to treatment-case report and review of the literature.

Leiomyosarcoma of the prostate is a rare and aggressive tumor, with a quarter of the patients harboring metastatic disease, commonly in the lung. It usually presents with urinary obstruction in a relatively younger patient group. A 29-year-old male presented with lower urinary tract symptoms to the urologist. Computed tomography scan revealed a large pelvic mass involving the prostate. Biopsy on two occasions yielded leiomyoma. Instead of conventional radical surgery, en-bloc resection of the mass was done while preserving the remaining portion of the prostate, seminal vesicles, and ejaculatory duct. Histopathology revealed a high-grade leiomyosarcoma with negative margins. The patient had excellent recovery of defecation, erectile, and ejaculatory functions within 2 months after adjuvant radiotherapy. At the 24-month follow-up there was no evidence of disease. En-bloc resection of the tumor can be considered in select cases to improve functional outcomes and sustain a higher quality of life in patients.

Analysis of Risk Factors for Postoperative Dysuria in Patients Undergoing Thoracotomy under General Anaesthesia.

BACKGROUND: Thoracotomy under general anaesthesia is one of the most difficult surgeries and is prone to result in postoperative complications. This study explored risk factors for postoperative dysuria in patients undergoing thoracotomy under general anaesthesia to provide a reference for the formulation and selection of subsequent clinical management programs. METHODS: Patients undergoing thoracotomy under general anaesthesia (n = 179) admitted to our hospital from June 2019 to June 2021 were selected. They were divided into dysuria group (n = 79) and normal urination group (n = 100) according to whether they had dysuria after surgery. Logistic regression analysis was conducted to explore risk factors affecting postoperative dysuria. RESULTS: Univariate analysis showed that dysuria was related to gender, age, surgical time, intraoperative and postoperative infusion volume, usage time of analgesic pump and retention time of urethral catheter (p < 0.001). Logistic regression analysis showed that male, age ≥60 years, surgical time ≥120 min, intraoperative infusion volume >1200 mL, postoperative infusion volume >800 mL, analgesic pump usage time ≥18 h and urethral catheter retention time of ≥72 h were risk factors for postoperative dysuria. CONCLUSIONS: The occurrence of postoperative dysuria in patients undergoing thoracotomy under general anaesthesia is related to gender, age, surgical time, intraoperative infusion volume, postoperative infusion volume, usage time of analgesic pump and retention time of urethral catheter. Clinical attention should be given to this patient group, and targeted intervention measures should be implemented.

Antibiotic utilization and symptom improvement in a retrospective cohort of women with urinary tract infection symptoms.

INTRODUCTION AND HYPOTHESIS: Urinary tract infections (UTIs) are one of the most common bacterial infections in women. We hypothesized that over half of those treated empirically would receive inappropriate antibiotics, those treated expectantly would have lower symptom improvement without antibiotics, and that overall progression to sequelae would be uncommon. METHODS: In this retrospective cohort study of women with UTI symptoms, we quantified the proportion who received inappropriate antibiotics in those treated empirically, defined as those with a negative urine culture or antibiotics that were changed according to culture sensitivities, and identified factors associated with symptom improvement during expectant management. Secondarily, we sought to determine the proportion of UTI sequelae in both groups. During the study time frame, a modified UTI Symptom Assessment (UTISA) questionnaire was administered at baseline and again, with a global rating for change instrument, when urine culture results were relayed. RESULTS: Analyses included 152 women, mean age 66.5 (SD 15.0) years, 30 (20%) received empiric antibiotics, and 122 (80%) expectant management. At baseline, the empiric group reported greater mean scores for dysuria (p < 0.01), urgency (p < 0.01), frequency (p < 0.01), and incomplete emptying (p < 0.01). Positive culture results were reported for 16 (53%) in the empiric group and 72 (59%) in the expectant group. Inappropriate antibiotics were prescribed to 18 (60%) of the empiric group. A negative urine culture was associated with improvement in symptoms in the expectant group. No subjects experienced UTI sequelae within 30 days of initial evaluation. CONCLUSION: In our cohort of older women with UTI symptoms, deferring antibiotics until urine culture  resulted appeared to be safe and decreased the use of inappropriate antibiotics.

Characters of Bacterial Vaginosis and Association with Dyspareunia and Dysuria in Pregnant Women in Saudi Arabia.

Background: Bacterial vaginosis is one of the most frequent vaginal tract infections during pregnancy. It is characterized by elevated vaginal pH, milky, creamy discharge, and an amine- or fishy-smelling odor. Study Aim: Our study aimed to describe the characteristics and presenting manifestations of bacterial vaginosis in pregnant women. Methods: This cross-sectional analytical study included pregnant Saudi women who have been diagnosed with bacterial vaginosis. Data was collected using a self-administered questionnaire. We used the Statistical Package for Social Sciences (SPSS) version 26 for data management and statistical analysis. Results: The study included 456 women and found that 59.7% of people felt vulval itching, 7.7% reported swelling, 81% reported increased secretions, 62.5% reported dyspareunia, and 44.6% reported burning micturition. Thirty-one percent of individuals reported yellowish discharges, while 32.1% reported a foul odor. Older women with lower educational levels, who had vaginal itching and swelling, had significantly higher rates of burning urination. Conclusion: Our study found that most of the presenting symptoms were significantly associated with dyspareunia and dysuria. The study also shows that nearly all the participants recovered with proper treatment. We recommend healthcare systems meticulously detect and cure bacterial vaginosis as it is a preventable cause of complicated pregnancy.

Xanthogranulomatous cystitis and bilateral ureteral reflux due to bladder neck obstruction: a case report.

Xanthogranulomatous cystitis (XC) is a rare benign disease of chronic granulomatous inflammation. We report a 23-year-old woman with xanthogranulomatous cystitis. She was referred to our hospital with the chief complaint of a 1-year history of frequent, urgent dysuria with recurrent fever. An imaging examination showed bilateral ureteral reflux and a normal bladder. Urodynamic findings suggested bladder outlet obstruction and increased post-void residual urine. Finally, the patient underwent endoscopy, and bladder neck obstruction was confirmed. Additionally, we found multiple granulomatous masses in the bladder. Therefore, we performed transurethral resection of the tumor and bladder neck. A histopathological examination of resected tumor tissue showed xanthogranulomatous cystitis, and the patient received anti-infective therapy. Follow-up cystourethroscopic results and urination symptoms returned to normal, and the bilateral ureteral reflux was gradually reduced.

Leiomyoma of the Prostate Treated via Holmium Laser Enucleation: A Case Report and Literature Review.

Leiomyoma is a rare tumor that arises from mesenchymal cells, with few reported cases of treatment using holmium laser enucleation of the prostate. A 74-year-old man with dysuria had a mass near the bladder neck in magnetic resonance imaging; this entity was suspected to be a leiomyoma. The patient underwent holmium laser enucleation of the prostate and one lobe was removed. However, the mass was firm and morcellation was difficult to break into small pieces. Therefore, it was fragmented via trans-urethral resection and removed with a curette. The postoperative course was favorable, with a positive clinical outcome. This case highlights the efficacy of holmium laser enucleation of the prostate in the management of prostatic leiomyoma and emphasizes its importance as a viable treatment option.