Intraoperative decision to change the course of management based on an ultrasonographic image of urinary bladder paraganglioma - a case study.

This case study concerns a 69-year-old woman qualified for transurethral resection of a primary tumor in a urinary bladder. Since a cystoscopic image did not correspond with typical urothelial carcinoma, an intraoperative ultrasonographic transrectal imaging was carried out, on the basis of which it was believed to be urinary bladder paraganglioma. Endoscopic treatment was abandoned. The patient was directed for further examination and next, on suspicion of extra-bladder phaeochromocytoma, scheduled for open surgery. Due to the location and range of the tumor, and systemic conditions, a radical cystectomy and Bricker's supravesical ureteroileal conduit were carried out. A postoperative histopathological examination confirmed the phaeochromocytoma character of the urinary bladder tumor.This case study concerns a 69-year-old woman qualified for transurethral resection of a primary tumor in a urinary bladder. Since a cystoscopic image did not correspond with typical urothelial carcinoma, an intraoperative ultrasonographic transrectal imaging was carried out, on the basis of which it was believed to be urinary bladder paraganglioma. Endoscopic treatment was abandoned. The patient was directed for further examination and next, on suspicion of extra-bladder phaeochromocytoma, scheduled for open surgery. Due to the location and range of the tumor, and systemic conditions, a radical cystectomy and Bricker's supravesical ureteroileal conduit were carried out. A postoperative histopathological examination confirmed the phaeochromocytoma character of the urinary bladder tumor.

TRUS-guided drainage of the ectopic ureter entering the prostatic urethra and TRUS-guided transurethral neo-orifice formation using holmium laser.

A fifty-nine year-old male was hospitalized for exacerbation of chronic pancreatitis. As a gigantic cyst of the pancreatic tail was identified, it was fused with the jejunal loop. Due to persistent fever and severe symptoms in the storage and voiding phases, the patient was referred to a urologist. Because transrectal ultrasound examination revealed a fluid collection resembling the left seminal vesicle filled with purulent material, a transrectal puncture procedure was performed. The analysis of computed tomography scans led to the diagnosis of duplicated collecting system of the left kidney with the enormous ureter of the upper moiety that entered the prostate gland. In order to permanently decompress the hydronephrosed upper moiety of the left kidney, the patient was deemed eligible for endoscopic treatment. A transurethral incision through the bladder wall and the adjacent segment of the ectopic ureter was made with holmium laser under transrectal ultrasonography guidance, thus creating a neo-orifice of this ureter.

Capillary hemangioma of the testis. A case report of a rare benign tumor.

This paper presents the case of a very rare capillary hemangioma of the testis in a 23-year-old patient. Physical examination revealed a tumor located in the upper pole of the left testis, which was suspected of being malignant due to its significantly increased density and irregular contours. Blood levels of the following tumor markers were determined: alpha-fetoprotein, human chorionic gonadotropin and lactate dehydrogenase. No abnormalities were found in any of these tests. A gray-scale ultrasound scan of the scrotum revealed a lesion located in the upper pole of the left testis, 24 mm in diameter with slightly decreased echogenicity and irregular contours, which suggested infiltration of the tunica albuginea of the testis. Color and power Doppler scans demonstrated a dense network of blood vessels and increased blood flow in the lesion described. In addition, 3D ultrasound scan images were obtained, which allowed for a thorough determination of the topography of the lesion. No abnormalities were found in the patient's medical history, physical examination or ultrasound scan of the right testis. Taking into account the suspected malignancy with signs of infiltration of the tunica albuginea of the upper pole of the testis a decision was made to remove the left testis together with the spermatic cord using the inguinal approach. A histopathological examination of the whole specimen revealed a multifocal capillary hemangioma of the testis, signs of testicular fibrosis and significant atrophy of the spermatogenic epithelium of the seminiferous tubules. Immunohistochemistry: CD31 (+), CD34 (+), FVIII (-), vimentin (+), CK MNF116 (-), mesothelial cells (-), calretinin (-), MIB-1 = 8.4%. The tumor described is one of the few benign lesions originating from the tissues of the testis for which partial resection of the organ may be considered. Intraoperative histopathological examination and resection of the lesion with the preservation of a healthy tissue margin may be considered in patients with a single testis in whom the tumor is found to have a very rich vascular network and the levels of tumor markers are normal.

Granulomatous prostatitis after intravesical immunotherapy mimicking prostate cancer.

Intravesical immunotherapy with attenuated strains of Mycobacterium bovis is a widely used therapeutic option in patients with non-muscle-invasive transitional cell carcinoma of the bladder. A rare complication of intravesical therapy with the Bacillus Calmette-Guérin vaccine is granulomatous prostatitis, which due to increasing levels of prostate-specific antigen and abnormalities found in transrectal examination of the prostate may suggest concomitant prostate cancer. A case of extensive granulomatous prostatitis in a 61-year-old patient which occurred after the first course of a well-tolerated Bacillus Calmette-Guérin therapy is presented. Due to abnormalities found in rectal examination and an abnormal transrectal ultrasound image of the prostate with extensive infiltration mimicking neoplastic hyperplasia a core biopsy of the prostate was performed. Histopathological examination revealed inflammatory infiltration sites of tuberculosis origin.

[Pre-emptive ketoprofen for postoperative pain relief after urologic surgery]. / Przydatnsc przedoperacyjnego zastosowania ketoprofenu w celu leczenia bólu pooperacyjnego po zabiegach urologicznych.

BACKGROUND: Effective multimodal postoperative analgesia is one of determinants of patient satisfaction after successful surgery. Following the recommendations of non-steroidal antiinflammatory agents (NSAIDs) for pre-emptive analgesia, we assessed the efficacy of ketoprofen administered before urological surgery. METHODS: Fifty-two ASA I and II adult patients, scheduled for elective urologic procedures under general anaesthesia, were enrolled in this prospective, double blind study. They were randomized to receive intravenously either 100 mg ketoprofen or placebo (0.9% saline), one hour before the procedure, and at 8, 24, 36 and 48 h after. Pethidine was given for rescue analgesia. VAS was used for pain scoring. RESULTS: Pain scores were similar in both groups and identified as severe (VAS >4) during the first 48 h after surgery. There was no difference in the number of patients requiring rescue pethidine analgesia, mostly required during the first 12 postoperative hours. CONCLUSION: Pre-emptive analgesia with intravenous ketoprofen was ineffective in patients undergoing urological surgery.

Bladder outlet obstruction in women: difficulties in the diagnosis.

OBJECTIVE: To identify the difficulties in diagnosing bladder outlet obstruction in women. MATERIAL AND METHODS: 53 women with a mean age of 37.2 (range 16-70) with chronic lower urinary tract symptoms and no neurogenic or organic diseases were examined. The prevalent symptoms were frequency (96%), urgency (92%) and nocturia (75%), and the mean duration of symptoms was 3.8 years. After pressure-flow studies and voiding cystourethrography were conducted, patients either underwent bladder neck or urethral incisions based on their diagnosis. These patients were subsequently subjected to follow-up uroflow studies. RESULTS: Abnormal uroflow curves were observed in 19 of 53 women. In 10 of them (52.6%), bladder outlet obstruction based on pressure-flow results was confirmed. Voiding cystourethrography results from these 19 women confirmed that 17 patients had bladder neck obstruction, while the remaining 2 had urethral obstruction. 16 of 19 were treated endoscopically, with 14 patients undergoing bladder neck incisions through the 5- and 7-o'clock positions and 2 patients having a distal urethral incision through the 12-o'clock position. In all of these 16 cases, there were both a statistical increase in the maximum flow rate (Qmax) as well as an improvement in the flow curves. Symptomatic improvement was observed in 12 of the 16 women subjected to surgical intervention. CONCLUSION: Bladder outlet obstruction exists in women with lower urinary tract symptoms. Pressure-flow studies and voiding cystourethrography are reliable modalities for confirming bladder outlet obstruction. Bladder outlet obstruction can be functionally or structurally caused.

[Treatment of condylomata acuminata with the neodymium laser]. / Leczenie klykcin konczystych za pomoca lasera neodymowego.

The effectiveness of neodymium laser therapy was presented in the treatment of urogenital condyloma acuminata in 55 patients (51 men and 4 women). The patients were followed up 14 days, 4 weeks, 3 months and 6 months after the laser treatment. The main localization of condyloma acuminata was foreskin and glans penis. The cure rate after the 1st session of treatment was 76%, 8.5% of patients required 3 sessions of the laser therapy. After 6 months 7 patients discontinued the follow-up, 89.6% (43 patients) were cured, 2 had the scars of foreskin and 3 suffered from recurrences. Neodymium laser treatment of urogenital condyloma is a safe treatment and no major side effects were encountered.

[Ureter injury as a gynecologic surgery complication--prospects for conservative treatment]. / Uszkodzenie moczowodu jako powiklanie operacji ginekologicznej--mozliwosci leczenia zachowawczego.

There we presented three cases of ureteral injury after gynecological operations. In two cases partial ureteral obstruction was treated by creating percutaneous renal fistula. In the latter case, in spite of conservative treatment (double J catheter), a uretero-vaginal fistula was detected.