ABSTRACT
Vesicovaginal fistula (VVF) continues to be a major public health problem in developing countries. Given the particular association of VVF with stones, the question that arises is whether the fistula is primary or secondary to bladder stone and then whether to use single-stage or two-stage treatment. But what is special about this study is that these rare clinical features are due to tuberculosis. We here report the case of a 62-year old female patient with a history of treated tuberculous spondylodiscitis. The patient had been declared cured 4 years before. For the previous 2 years she had been suffering from continuous urinary incontinence. Clinical examination showed almost complete vaginal synechia. Complementary scannography and cystography showed the presence of 3 stones on the way to the VVF. The largest stone measured 6cm along its longer axis with passage of contrast material into the uterovaginal cavity through the fistula. The patient was admitted to the operating room where she underwent cystolithotomy with ablation of the stones that were on the way to the fistula, biopsy of the fistulous tract and single-stage closure of the VVF in two layers without interposition of the autologous tissue. Anatomopathological results confirmed the presence of active tuberculosis on the way to the fistula, requiring resumption of antibacillary treatment for 9 months. During the follow-up visit at 3, 6 and 9 months the patient showed good clinical status with absence of urinary incontinence. VVF secondary to tuberculosis associated with urinary stones appears very little in literature. Our case demonstrates the feasibility of antibacillar medical treatment associated with single-stage surgical treatment with very satisfactory results despite the history of our patient and the duration of his disease.
Subject(s)
Tuberculosis, Spinal/diagnosis , Urinary Bladder Calculi/diagnosis , Urinary Incontinence/etiology , Vesicovaginal Fistula/diagnosis , Antitubercular Agents/administration & dosage , Biopsy , Discitis/microbiology , Female , Follow-Up Studies , Humans , Middle Aged , Treatment Outcome , Tuberculosis, Spinal/complications , Tuberculosis, Spinal/drug therapy , Urinary Bladder Calculi/pathology , Vesicovaginal Fistula/etiologyABSTRACT
BACKGROUND: Rhabdomyosarcoma of the urinary bladder in adults is an extremely rare malignant neoplasm that develops from the bladder wall. CASE PRESENTATION: We report our experience of a rare case of rhabdomyosarcoma of the bladder in a 45-year-old Moroccan man who was successfully managed with neoadjuvant chemotherapy and surgical excision of the mass; he was disease free at 24-month follow up. CONCLUSIONS: To the best of our knowledge, this is the first reported case of a rare embryonal rhabdomyosarcoma of the bladder that was managed with neoadjuvant chemotherapy and surgery. This is why further studies using a large number of patients with a greater longitudinal follow up will be required.
Subject(s)
Antineoplastic Agents/therapeutic use , Neoadjuvant Therapy/methods , Rhabdomyosarcoma, Embryonal/drug therapy , Rhabdomyosarcoma, Embryonal/surgery , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/surgery , Humans , Male , Middle Aged , Morocco , Rare Diseases/diagnosis , Rare Diseases/physiopathology , Rare Diseases/therapy , Rhabdomyosarcoma, Embryonal/diagnosis , Rhabdomyosarcoma, Embryonal/physiopathology , Treatment Outcome , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/physiopathologyABSTRACT
Embryonic paratesticular rhabdomyosarcoma is a rare mesenchymal tumor constituting a diagnostic and therapeutic emergency. Localized forms have a favorable prognosis. Multimodal treatment is the gold standard and it is based on surgery, multidrug chemotherapy and radiotherapy, with excellent overall survival rate. We here report the case of a 17-year old patient treated in our Department for embryonic fusiform cell paratesticular rhabdomyosarcoma causing clinical confusion. This study aims to highlight the specific features of this disease.