Eosinophilic cystitis and cholangitis - systemic disease triggered by mycobacterium tuberculosis?

Eosinophilic cystitis (EC) is a rare inflammatory disorder of the urinary tract characterized by infiltration of bladder with eosinophils. The cause remains unclear, immunological mechanisms have been implicated in pathogenesis. Potential etiological factors include: tumors, allergy, parasitic infections, trauma. The disease may have a variable course, from a mild self-limiting, through common symptoms like: dysuria, hematuria, abdominal pain, tumor, to severe renal failure, with eosinophilic infiltration of the other organs and systemic complications. Treatment depending on disease severity and etiology is pharmacological and/or surgical. Here we report a case of a previously healthy 16-year old girl with inflammatory tumor in the liver hilum infiltrating extrahepatic biliary tract who developed three months later haematuria with acute dysuric signs and renal failure. Based on histopathological findings diagnosis of eosinophilic cystitis was established. Tests for Mycobacterium tuberculosis were positive. To our knowledge, EC association with cholangitis and tuberculosis have never been reported before.

Eosinophilic cystitis and cholangitis - systemic disease triggered by mycobacterium tuberculosis?

Eosinophilic cystitis (EC) is a rare inflammatory disorder of the urinary tract characterized by infiltration of bladder with eosinophils. The cause remains unclear, immunological mechanisms have been implicated in pathogenesis. Potential etiological factors include: tumors, allergy, parasitic infections, trauma. The disease may have a variable course, from a mild self-limiting, through common symptoms like: dysuria, hematuria, abdominal pain, tumor, to severe renal failure, with eosinophilic infiltration of the other organs and systemic complications. Treatment depending on disease severity and etiology is pharmacological and/or surgical. Here we report a case of a previously healthy 16-year old girl with inflammatory tumor in the liver hilum infiltrating extrahepatic biliary tract who developed three months later haematuria with acute dysuric signs and renal failure. Based on histopathological findings diagnosis of eosinophilic cystitis was established. Tests for Mycobacterium tuberculosis were positive. To our knowledge, EC association with cholangitis and tuberculosis have never been reported before.

Volume of the normal prostate gland in polish boys, aged 1-17 years: Based on transabdominal ultrasound - Prospective study.

BACKGROUND: Until now, there are no established norms for prostate size in children. Prostate volume during development has been analyzed in small study groups. In diagnostic imaging, transabdominal ultrasound and magnetic resonance imaging are used. AIMS: To establish prostate volume norms for individuals aged 1-17 years using transabdominal ultrasound. STUDY DESIGN: Between 2021 and 2023, transabdominal prostate ultrasound was performed on 482 Caucasian boys, aged 1-17 years, who were patients of the urology clinic. Normative data were based on results of 345 boys with normal lower urinary tract, urethral and penile structures. Patients with abnormal external genitalia, Prune Belly Syndrome, Myelomeningocele, chromosomal disorders, or prostate abnormalities found in ultrasound were excluded from the study. Patient eligibility was determined based on medical records and physical examinations. During ultrasound, height, anterior-posterior dimension, and width of prostate were assessed. Prostate volume was calculated using the ellipsoid formula VH x L(AP) x W x 0.523. Measurements were correlated with age, weight, and height. Results were analyzed using descriptive statistics, statistical significance tests for means, and correlation methods. After estimating preliminary results, taking into account the development periods, patients were divided into age groups: 1-4 years (n = 70), 5-10 years (n = 124), 11-12 years (n = 43), 13-15 years (n = 65), and 16-17 years (n = 43). RESULTS: The table and nomogram shows prostate volumes based on age. Prostate size remains stable up to the age of 8. We noticed a transitional phase at the age of 8-11 years. A significant increase in volume occurs over 11 years of age. There was a statistically significant relationship between prostate size, age, height, and weight. DISCUSION: Established norms can serve as a reference for prostate analysis in patients with defects of the genitourinary system. An interesting analysis would be a prostate size assessment in relation to stage of development on Tanner scale. CONCLUSION: Transabdominal ultrasound, being a non-invasive, painless, and readily accessible examination, allows assessment of prostate size even in boys aged 1 year old. A statistically significant relationship was found between prostate size, weight, and height. Norms for prostate size in boys were established according to age.

The Need for Earlier Diagnosis of Obstructed Hemivagina and Ipsilateral Renal Agenesis/Anomaly (OHVIRA) Syndrome in Case of Renal Agenesis in Girls-Case Report and Review of the Literature.

Obstructed hemivagina and ipsilateral renal agenesis/anomaly (OHVIRA) syndrome is a very rare condition affecting girls. The time of diagnosis varies, from cases of prenatal diagnosis up to adulthood, including pregnancy or delivery. Most commonly, it is recognised during puberty and usually as an acute condition. We present a case report of an adolescent girl who underwent the treatment because of acute abdominal pain. The case is interesting due to a previous diagnosis of one-side renal agenesis. It appears to be useful to perform a diagnostic pelvic imaging at the time of diagnosis of renal agenesis or to plan to perform it at the beginning of puberty, to prevent the need for urgent surgery. This management may allow the planning of proper follow-up, minimising the risk of possible complications.

[Neuropathic bladder dysfunction]. / Neurogenna dysfunkcja pecherzowo-cewkowa.

The knowledge that after closure of the spinal cord defect, function of pelvic floor can change from hypocontractility to overactivity within the first months of life, is very important for successful treatment. All newborns at that time have residual urine after a spontaneous void. The most authors therefore recommend to start all newborns on intermittent catheterisation every 3 hours. The pattern of bladder dysfunction (Sillen 1996) changes within the first year of life towards moderate or severe overactivity with accompanying bladder-sphincter dyssynergy. Bauer (2000) observed that 14% of children with synergy initially deteriorated due to a conversion to dyssynergy, 30% of infants with absent sphincter activity in the beginning developed reflux or hydronehrosis due to denervation fibrosis of the external sphincter and high outlet resistance. One third of these changes were seen before one year of age, but 82% before age two. From these reasons highly beneficial is immediately, after closure of spinal cord defect, to perform ultrasound examination with calculation of residual urine and urodynamic evaluation. It clearly proves the beneficial role of anticholinergics and CIC with 63% of refluxes treated successfully. In patients whose reflux resolved bladder volume and bladder compliance improved and leak point pressure was markedly reduced.

[Non-neurogenic lower urinary tract dysfunction]. / Nieneurogenne zaburzenia czynnosci dolnych dróg moczowych.

Functional bladder disorders in children are a common condition and they are observed in 5-15% of pediatric population. Recent observations of bladder function of the healthy newborns have changed our viewpoint on its behaviour in older children. By the age of 4 years, many if not most children have matured their urinary tract function and developed an adult pattern of urinary control. They are generally dry during the day and the night. The adult pattern is characterized during bladder filling by an absence of unstable or uninhibited (involuntary) detrusor contractions. Urodynamic studies have confirmed that even at bladder capacity and when the desire to void is strong, detrusor contraction will not occur unless it is voluntarily initiated. The voiding symptoms and urinary incontinence or urinary infection and are thought to be caused by behavioral factors that affect toilet training and prevent successful transition from the infantile to the adult pattern of urinary control. These syndromes of dysfunctional elimination differ greatly in manifestation, prognosis, and pathophysiology and comprise a clinical spectrum that varies widely. At the severe end of the spectrum are a small group of patients with Hinman's syndrome, also termed the non-neurogenic neurogenic bladder, dysfunctional voiding, or occult neuropathic bladder. Less severe uropathology is observed in the large group of children who present with refractory and often severe symptoms that reflect incomplete toilet training with diminished urinary control. Their obstruction is caused by an incoordination between bladder and sphincter that occurs only during bladder filling in the presence of unstable bladder contractions and is, therefore, of less potential risk to the urinary tract. Unstable bladder, the most common pattern of urinary dysfunction in childhood, occurs in up to 57% of symptomatic children aged 3 to 14 years. Voluntary constriction of the urinary sphincter during unstable bladder contractions produces urinary obstruction with high intravesical pressures. The assessment of children with lower urinary tract disorders should consist of a detailed history, a frequency/volume chart and a physical examination. Uroflowmetry and ultrasound examination can be added. Treatment of functional bladder disorders in children can be divided in urotherapy, consisting of standard therapy and some specialized types of urotherapy like biofeedback, neuromodulation, pharmacotherapy and botulinum toxin injections.

[Evaluation of the central nervous system in children with bladder dysfunction with the use of evoked potentials]. / Ocena osrodkowego ukladu nerwowego u dzieci z dysfunkcja pecherza moczowego za pomoca potencjalów wywolanych.

The function of the central nervous system and especially spinal cord and brainstem, were evaluated. Brainstem (BAEPs) and somatosensory evoked potentials (SEPs) were used with the stimulation of the peroneus nerve in 52 children at the age of 4.4 up to 18 years (mean age 11.9) with chronic bladder dysfunction of various etiology. Abnormal evoked potentials were recorded in 34 patients. The most frequent abnormality in SEPs was delayed latency of central conduction time and in L5-Th 10. BAEPs demonstrated atopic morphology of III-IV wave records. All performed evoked potential examinations confirmed that the dysfunction of the central nervous system may result in failure treatment in these children.