Dysuria, Rebound Tenderness, and a Palpable Mass-A Ticking Time Bomb.

A 37-year-old male presented to the emergency department with the complaint of periumbilical abdominal pain, radiating to just above pubic symphysis. The patient reported that the pain was worse with urination and associated with chills and nausea. This case reports discusses the Emergency Department (ED) course and subsequent treatment of a patient found to have an infected urachal cyst, a previously asymptomatic embryological anomaly in an otherwise healthy middle-aged adult male. This is a crucial diagnosis to make in order to avoid the potential for significant morbidity and/or mortality, given the unlikely symptomatic source.

Sclerosing Adenosis of the Prostate-A Benign Lesion Similar to Prostate Cancer: A Case Report and Literature Review.

Sclerosing adenosis of the prostate (SAP) is a rare benign non-neoplastic small acinar hyperplasia. Like sclerosing adenosis of the breast, which is confused with breast cancer, SAP is a trap in the pathological differential diagnosis of benign and malignant lesions of the prostate. We report such a case to help colleagues better distinguish and diagnose such diseases. A 75-year-old patient with SAP had a prostate specific antigen (PSA) level of 11.0 ng/mL, and he had been suffering from progressive dysuria for 3 years. The central glandular area and the right periphery of the prostate were found to have nodular low signals on magnetic resonance imaging (MRI). Prostate biopsy showed that basal cells were positive for P63 and P504s, few basal cells were positive for S-100, and the positive rate of Ki67 was approximately 2%. We consider that the possibility of SAP is high. The patient was treated conservatively and was discharged in good health, free of dysuria and other problems. SAP is a rare benign lesion that is easily misdiagnosed as prostate cancer. The prostatic gland tube has a complete basal cell layer surrounding it, as well as myoepithelial cell metaplasia of basal cells, which is a key trait in distinguishing it from prostate cancer. Although the latest research indicates that SAP does not require treatment, the question of whether it is a risk factor for prostate cancer remains unanswered.

Extragenital Endometriosis in the Differential Diagnosis of Non- Gynecological Diseases.

BACKGROUND: Endometriosis is a chronic, benign disease that affects approximately 10% of women of childbearing age. Its characteristic clinical features are dysmenorrhea, dyschezia, dysuria, dyspareunia, and infertility. The manifestations of extragenital endometriosis (EE) are a diagnostic challenge, as this disease can mimic other diseases due to its unusual location with infiltration of various organs and corresponding symptoms. METHODS: This review is based on publications retrieved by a selective search of the literature on the commonest extragenital sites of endometriosis, including the relevant current guideline. RESULTS: Current evidence on the treatment of extragenital endometriosis consists largely of cohort studies and cross-sectional studies. The treatment is either surgical and/or conservative (e.g., hormonal therapy). Gastrointestinal endometriosis is the most common form of EE, affecting the rectum and sigmoid colon in nearly 90% of cases and typically presenting with dyschezia. Urogenital endometriosis is the second most common form of EE. It affects the bladder in more than 85% of cases and may present with dysuria, hematuria, or irritable bladder syndrome. The diaphragm is the most common site of thoracic endometri - osis, potentially presenting with period-associated shoulder pain or catamenial pneumothorax. Endometriosis affecting a nerve often presents with sciatica. In abdominal wall endometriosis, painful nodules arise in scars from prior abdominal surgery. CONCLUSION: There is, as yet, no causally directed treatment for chronic endometriosis. The treatment is decided upon individually in discussion with the patient, in consideration of risk factors and after assessment of the benefits and risks. Timely diagnosis is essential.

Disuria en una mujer de 24 años / Dysuria in a 24 years old woman

No disponible

Comparison of Multipulse Laser Vaporesection versus Plasmakinetic Resection for Treatment of Benign Prostate Obstruction.

We aimed to compare the efficacy and safety of Multipulse laser vaporesection of the prostate (MPVP) versus plasmakinetic resection of the prostate (PKRP) for treatment of patients with benign prostate obstruction (BPO) in a prospective trial. From January 2016 to April 2017, a total of 144 patients were included in the cohort study, of whom 73 patients underwent MPVP and 71 underwent PKRP. All patients received pre-operative evaluation and followed up at 1, 3, 6 and 12 months postoperatively. Baseline characteristics, perioperative data and postoperative outcomes were compared. Early (within 30 days postoperatively) and late complications were also recorded. Preoperative data, including age, prostate volume, international prostate symptom score (IPSS), International Index of Erectile Function Questionnaires (IIEF-5), the rate of anticoagulants use, Charlson comorbidity index were similar in two groups. Peri-operative parameters, including the rate of transfusion, and decrease in hemoglobin level were comparable. The operative time, the duration of catheterization and length of hospital stay were significantly shorter in the MPVP group. The voiding parameters and the quality-of-life scores (QoL) improved significantly in both groups postoperatively. There was a significantly difference in QoL at 1-year in the MPVP group (p < 0.001), under mixed model analysis with random effect and Bonferroni correction. There were no significant differences in improvement of IPSS, Qmax, IIEF-5, residual prostate volume ratio and PSA level reduction at the 1-year follow-up. MPVP was significantly superior to PKRP in terms of a reduction in overall complication rate (21.9% vs 45.0%, p = 0.004). Both treatments led to comparable symptomatic improvements. MPVP demonstrates satisfactory efficiency, shorter catheterization time and shorter hospital stay. Our data revealed that MPVP may be a promising technique which is safe and favorable alternative for patients with BPO.

Accuracy of urinary symptoms and urine microscopy in diagnosing urinary tract infection in women.

BACKGROUND: Women with urinary tract infections (UTIs) often present with urinary complaints such as frequency of micturition, dysuria, foul-smelling urine and other non-specific symptoms like fever. Physicians may order urine microscopy to guide empirical antibiotic prescription. However, the performance of this approach has not been assessed. OBJECTIVES: This study aimed to determine the accuracy of UTI symptoms and urine microscopy associated with culture-positive UTI in Asian women. METHODS: A cross-sectional study of adult women who presented with UTI-related symptoms was conducted at three public primary care clinics in Singapore. Demographic data and information on their symptoms were collected, followed by urine microscopy and culture to diagnose UTI. The sensitivity, specificity, positive (PPV), negative predictive values (NPV), accuracy (ACC) and area under curve (AUC) of combinations of symptom and urine investigations were analysed in association with culture-positive UTI, which was regarded as a benchmark. RESULTS: Data on 564 women (73.9% Chinese, 11.5% Malay, 8.2% Indian) were analysed, of which 259 (45.9%) had culture-positive UTI. Frequency and foul-smelling urine, pyuria (WBC ≥10/hpf) and semi-quantitative bacterial count (≥2+) were significantly associated with positive urine culture. The ACC and AUC for single or multiple urinary and/or general symptoms were low. Urine pyuria (minimally >10/hpf) alone or in combination with symptoms and/or semi-quantitative bacterial count achieved high sensitivity (>85%) and PPV, NPV, ACC and AUC of >70%. CONCLUSION: Urinary symptoms have limited accuracy in diagnosing culture-positive UTI. Concurrent urine microscopy showing presence of pyuria and/or bacterial count increased the diagnostic accuracy of culture-positive UTI.

Low-Power Vs High-Power Holmium Laser Enucleation of the Prostate: Critical Assessment through Randomized Trial.

OBJECTIVE: To assess the non-inferiority of Low-power Holmium laser enucleation of the prostate (LP-HoLEP) to high-power (HP-HoLEP) for enucleation efficiency pertaining to the advantages of lower cost and minimal postoperative dysuria, storage symptoms, and negative sexual impact. PATIENTS AND METHODS: HoLEP was performed using 100W Versapulse, Luminis Inc., with 2J/25Hz for LP-HoLEP (61 patients) and 2J/50Hz for HP-HoLEP (60 patients). Two surgeons with different experience performed equal number of both procedures. Non-inferiority of enucleation efficiency (enucleated weight/min) was evaluated. All perioperative parameters were recorded and compared. Dysuria was assessed at 2 weeks by dysuria visual analog scale, urinary (Q.max and IPSS) and sexual (sexual health inventory for men score) outcome measures were evaluated at 1, 4, and 12 months. RESULTS: Baseline and perioperative parameters were comparable between the two groups. Mean enucleation efficiency was 1.42±0.6 vs 1.47±0.6 gm/min, P = .6 following LP-HoLEP and HP-HoLEP, respectively. Patients reported postoperative dysuria similarly in both groups as per dysuria visual analog scale. There was significant comparable improvement in IPSS (international prostate symptom score) and Q.max in both groups at different follow-up points. At one year, median IPSS and Q.max were comparable in both groups (P = .4 and .7 following LP-HoLEP and HP-HoLEP, respectively). Median postoperative reduction in prostate specific antigen was 89% (42:99) following LP-HoLEP vs 81% (62:94) after HP-HoLEP, P = .92. Both groups showed comparable perioperative and late postoperative complications. There were no statistically significant changes in the last follow-up sexual health inventory for men score in comparison to baseline score. CONCLUSION: LP-HoLEP is non-inferior to HP-HoLEP in terms of all efficiency parameters regardless level of surgeon experience.

Penoscrotal Transposition to Achieve Urethral Continuity After Long-Segment Urethral Defect: A Case Report.

Penoscrotal transposition and pendulous-prostatic anastomotic urethroplasty for the treatment of long-segment bulbar and membranous urethral stenosis is rarely reported. This study reports the case of a 43-year-old man with dysuria resulting from pelvic fracture. The patient had a long-term history of multiple urethral reconstructions and presented a long-segment bulbar and membranous urethral stenosis at imaging. Penoscrotal transposition and pendulous-prostatic anastomotic urethroplasty was performed and completed in 170 min (blood loss: 400 ml). Postoperative treatment was uneventful with favorable short-term outcomes and high patient satisfaction without recurrence at 12-month follow-up. This surgical technique should be attempted in carefully selected patients with long-segment bulbar and membranous urethral stenosis and performed by an experienced urethral reconstruction specialist.

Clinical findings and diagnostic procedures in 270 small ruminants with obstructive urolithiasis.

BACKGROUND: Details of the clinical signs of obstructive urolithiasis in male small ruminants have not been documented in a large population. OBJECTIVE: To describe the clinical presentation and diagnostic procedures in a large group of small ruminants with urolithiasis. ANIMALS: Two hundred and seventy small ruminants (158 sheep and 112 goats). METHODS: Retrospective study of 270 cases identified based on clinical records. RESULTS: 81.2% affected goats were castrated and 91.7% sheep were intact males; 65.5% of the animals had been sick ≤2 days before referral. Common abnormalities included dysuria (93.6%), indigestion (84.4%), reduced general state of health (79.5%), signs of pain (73%), increased heart and respiratory rates (53.6% and 39.1%), and azotemia (89.4%). Blood urea nitrogen (BUN) and creatinine concentrations were strongly correlated (r2 = 0.81). Hypochloremia (52.2%), hyponatremia (43.3%), hypophosphatemia (52.4%), and abnormal potassium concentrations (26.2% hypokalemia and 24.5% hyperkalemia) were the most common serum electrolyte imbalances. Packed cell volume (PCV), plasma proteins, potassium, BUN, and creatinine concentrations were significantly increased in animals with uroperitoneum. Ultrasonography allowed for confirmation of diagnosis in 83.9% of the cases (135/161 with sufficient available information), uroliths were visible on 34 of 56 plain radiographs. CONCLUSIONS AND CLINICAL IMPORTANCE: Our study confirmed that clinical and ultrasonographic examinations are sufficient to diagnose urolithiasis. Clinical signs can be divided into an early stage with discrete unspecific clinical signs, a painful stage with frequent straining, expression of pain and moderately reduced general condition, and an advanced stage with a markedly reduced general condition and eventually recumbency.

Self-reported toileting behaviors in employed women: Are they associated with lower urinary tract symptoms?

AIMS: To describe toileting behaviors working women habitually use and investigate behaviors associated with lower urinary tract symptoms (LUTS), especially urinary urgency with or without leakage. METHODS: Non-pregnant female employees of a large academic medical center 18 years and over were eligible to complete an online survey about bladder health and toileting behaviors. RESULTS: One hundred eighty-two women participated in the survey. The majority were white (83.52%), married (52.49%), had ≥1 pregnancy (54.40%), and in excellent health (93.41%). The average age and body mass index were 47.28 ± 13.56 years and 27.92 ± 6.78, respectively. The sample was further sub-divided into two groups: urinary urgency (N = 119) or no urinary urgency symptoms (N = 51). Habitual toileting behaviors for these groups (N = 170) included: sitting to urinate at home (98.24%), emptying the bladder completely (88.82%), emptying the bladder before leaving home (80.00%), and sitting to urinate when away from home (68.82%). Logistic regression analysis showed age increased the odds of urinary urgency (aOR 1.06, 95%CI 1.02-1.09). Women who waited too long to urinate at work (aOR 7.85, 95%CI 1.57-39.24) and wore panty liners for urinary leakage (aOR 2.86, 95%CI 1.25-6.56) had greater odds of urinary urgency than women who did neither. CONCLUSIONS: Most habitual toileting behaviors were not associated with urinary urgency except waiting too long to urinate when at work. Logistic regression revealed significant relationships among health-related factors, personal characteristics, behaviors, and urinary urgency. LUTS in women is both a women's health and occupational health issue.

A 26-Year-Old Man From Mexico With Headaches, Dysuria, and a Right Scrotal Mass.

CASE PRESENTATION: A 26-year-old man with no medical history was admitted to the hospital for evaluation of his change in mental status. He was noted to be agitated at work and had difficulty walking for 2 days before being brought in to the ED by his family. According to his uncle, the patient had been complaining of a headache and pain with urination for approximately 1 week. He was born in Guerrero, Mexico (a small farm town), and moved to Los Angeles, California, in 2008.

Child with Dysuria and/or Hematuria.

Dysuria and/or hematuria are common and worrisome symptoms for most parents. Dysuria results from excessive bladder muscle contraction and peristaltic activity of the edematous and inflamed urethral mucosa. Though urinary tract infection remains the commonest cause for dysuria, non-infectious causes should also be kept in mind. Equating all cases of dysuria to urinary infection is not incorrect. Hematuria can be both macroscopic and microscopic and an important sign of genitourinary tract disease. However, systemic causes like bleeding disorder or malignancy can also present with hematuria. A thorough history and physical examination is important for arriving at a diagnosis. The investigations for both the symptoms and the urgency with which the tests are required are dictated by the patient's clinical presentation.

Urinary Symptoms and Their Associations With Urinary Tract Infections in Urogynecologic Patients.

OBJECTIVE: To assess urinary symptoms associated with urinary tract infection (UTI) in a urogynecologic population of women. METHODS: In this cohort study, we enrolled 150 urogynecologic patients who completed the validated UTI Symptom Assessment questionnaire and contributed transurethral catheterized urine samples. The primary measure (UTI diagnosis) was defined in three ways. Self-report (a nonculture-based UTI diagnosis) was defined by a yes or no response to the query "Do you think you have a UTI?" Two culture-based UTI diagnoses also were analyzed: standard urine culture (10 colony-forming units [CFU]/mL or greater) and enhanced quantitative urine culture (10 CFU/mL or greater) of any uropathogen. Statistical analyses were performed on patient demographics and urinary symptom prevalence among patient groups. RESULTS: Although the presence of the urinary symptoms of frequency and urgency (respectively) differ somewhat between UTI-positive and UTI-negative women (self-report [P=.005 and P<.001], standard urine culture [P=.038 and P=.044], or enhanced quantitative urine culture [P=.059 and P=.098]), the presence of dysuria (pain or burning) during urination was significantly more prevalent in UTI-positive women for all UTI definitions (self-report P<.001, standard urine culture P<.001, and enhanced quantitative urine culture P=.010). Furthermore, women reporting dysuria had higher severity and bother scores for all other urinary symptoms assessed by the UTI Symptom Assessment questionnaire compared with women not reporting dysuria (frequency P=.001, urgency P=.006, dysuria P<.001). CONCLUSION: Our findings show that, in women seeking urogynecologic care, the presence of frequency and urgency of urination does not confirm a culture-based UTI diagnosis. Instead, clinicians can more readily detect UTI using the presence of dysuria, which more effectively discriminates UTI-positive and UTI-negative individuals, regardless of the culture-based method used to diagnose UTI.

Why we need a higher suspicion index of urolithiasis in children.

BACKGROUND: Most children with symptoms of urolithiasis and urinary solute excretion abnormalities leading to stone formation have no calculi revealed by ultrasound or X-ray plain film ("occult urolithiasis"). This covers a large group of children presenting with common symptoms such as abdominal pain, hematuria, and dysuria, often faced by general practitioners and pediatricians. However, half or more of children with urolithiasis could present with abdominal/flank pain without specific urinary symptoms. STUDY DESIGN: We review the current evidence about prevalence, clinical presentation, and radiological detection of overt and "occult" urolithiasis in children, aiming to give readers the instruments to suspect and diagnose urolithiasis while avoiding cost-ineffective and undue diagnostic procedures. CONCLUSIONS: It is important to investigate for urolithiasis first by ultrasound and, in specific cases, by urinary metabolic and different imaging studies in the following groups: 1) in children with non-glomerular hematuria or/and dysuria not presenting inflammation of external genitalia; 2) in children with acute/sub-acute or infrequent recurrent abdominal pain and family history of urolithiasis in first or second degree relatives or being at higher risk of developing stones although hematuria and dysuria are lacking; 3) in children under 8 years old, even though pain is central or diffuse to the whole abdomen; and 4) in children presenting risk factors or conditions predisposing to urolithiasis. Finally, it seems reasonable to repeat ultrasound 1-2 years later also in children with "occult" urolithiasis and high risk of developing stones to detect any (re-)appearance of calculi.

The German linguistic validation of the Ureteral Stent Symptoms Questionnaire (USSQ).

PURPOSE: We developed and validated the German version of the Ureteral Stent Symptoms Questionnaire (USSQ) for male and female patients with indwelling ureteral stents. METHODS: The German version of the USSQ was developed following a well-established multistep process. A total of 101 patients with indwelling ureteral stents completed the German USSQ as well as the validated questionnaires International Prostate Symptom Score (IPSS) or International Consultation on Incontinence Questionnaire (ICIQ) and the Short Form Health Survey (SF-36). Patients completed questionnaires at 1 and 2-4 weeks after stent insertion and 4 weeks after stent removal. Statistical analyses were performed to assess the psychometric properties of the questionnaire. RESULTS: The German version of the USSQ showed good internal consistency (Cronbach's α = .72-.88) and test-retest reliability [intraclass correlation coefficient (ICC) = .81-.92]. Inter-domain associations within the USSQ showed substantial correlations between different USSQ domains, indicating a high conceptual relationship of the domains. Except from urinary symptoms and general quality of life, German USSQ showed good convergent validity with the corresponding validated questionnaires. All USSQ domains showed significant sensitivity to change (p ≤ .001). CONCLUSION: The new German version of the USSQ proved to be a reliable and robust instrument for the evaluation of ureteral stent-associated morbidity for both male and female patients. It is expected to be a valid outcome measure in the future stent research.