Megacystis with an anterior urethral valve: case report and review of literature.

Fetal megacystis, an abnormally enlarged bladder identified at any gestational age, may be transient and resolve spontaneously or may be an early manifestation of bladder outlet obstruction. Anterior urethral valves are the most common cause of the rare condition of congenital obstruction of the anterior urethra. Herein is reported the prenatal observation and postnatal management of a case of megacystis with anterior urethral valves. The etiology is reviewed and strategies recommended for patients with these rare entities.

Body mass index as a predictive value for complications associated with reconstructive surgery in patients with myelodysplasia.

PURPOSE: Patients with myelodysplasia often have urological pathology, with 25% to 40% requiring reconstructive procedures to achieve urinary and/or fecal continence. Complication rates from these major reconstructive procedures range between 10% and 50%. Additionally many of these patients have significant comorbidities, including a nonambulatory status that leads to an increased body mass index. It is currently unknown whether a high body mass index is associated with increased surgical complications. In this study we compare body mass index and postoperative complications. MATERIALS AND METHODS: We retrospectively reviewed the charts of all patients with myelodysplasia undergoing urinary or fecal reconstructive procedures. We analyzed data for body mass index and any documented complication occurring during hospitalization or at any time during followup. Patients were categorized based on body mass index as normal weight (less than 85th percentile), overweight (85th to 95th percentile) or obese (greater than 95th percentile). Statistical analyses using chi-square and Fisher's exact tests were then performed. RESULTS: Reconstructive procedures were carried out in 66 patients with myelodysplasia between 1997 and 2005. A total of 48 bladder augmentations were performed with a total of 101 stomas created. Mean followup was 39 months. Height and weight were available for body mass index calculation in 60 patients. Obesity was common in our patients with myelodysplasia, affecting 33% of the population (20 of 60 patients). We found a total of 53 complications in 31 patients (52%). There was a significant association between presence of complications and weight category, with complications occurring in 40% of normal weight, 40% of overweight and 75% of obese patients (p = 0.0380). An association between stomal stenosis and weight category was also found (p = 0.0373). In addition, multiple complications were more prevalent in obese patients. Of the 15 patients (25%) with 2 or more complications 10 (67%) were obese (p = 0.0066). CONCLUSIONS: Patients with myelodysplasia have a high incidence of obesity. Since obesity is associated with a higher complication rate, weight loss programs are highly recommended for obese patients with myelodysplasia before and after any reconstructive surgery.

A favorable outcome following 32 vesicocentesis and amnioinfusion procedures in a fetus with severe prune belly syndrome.

Patients with severe prune belly syndrome rarely survive beyond the first days of life. We present a case of prune belly syndrome that initially presented with severe oligohydramnios, megacystis and associated poor urine biochemistries. Due to an anteriorly located placenta the patient was referred to three major centers, but was turned down because of the unfavorable prognostic findings. Therefore, fetal intervention was performed with 32 vesicocentesis and amnioinfusion procedures. Despite the unfavorable prenatal findings, and having undergone numerous fetal interventions, the birth resulted in a viable infant.

Recurrent malignant melanoma of the penis.

We report the case of a 72-year-old man with arcal-lentiginous type melanoma of the penis who had undergone local excision and bilateral inguinal lymphadenectomy but developed recurrence at the subcoronal ridge of the glans penis. To our knowledge, this is the 10th reported case in English published studies. We believe this case demonstrates the importance of close follow-up postoperatively and to beware of the recurrence of penile melanoma in patients without total penectomy.

Hydronephrosis in a woman undergoing in vitro fertilization.

Obstruction of a ureter secondary to tumor, fibrosis, or inflammation has been well documented in published reports. A review of English studies revealed no reported cases of hydronephrosis of a native kidney resulting from hyperstimulation of an ovary. We report a case of hydronephrosis in a woman undergoing ovarian stimulation for in vitro fertilization. Her presentation was prompted by symptoms of flank pain with nausea and vomiting. Management with ureteral stent placement was successful in relieving the obstructive symptoms. This case demonstrates the importance of imaging and close monitoring of symptoms in women undergoing in vitro fertilization.