Bladder lesions as incidental findings during transurethral resection of the prostate: prevalence, diagnosis, and pathological findings.

PURPOSE: The purpose of this study was to determine the prevalence of bladder lesions diagnosed during transurethral resection of the prostate (TURP), to identify the associated risk factors, and to correlate the macroscopic descriptions with the pathological findings. METHODS: This was a single-center retrospective case series conducted at a hospital in the city of São Paulo, Brazil. We reviewed the medical and surgical records of patients who underwent TURP between January 2012 and December 2017. RESULTS: The final sample comprised 513 patients, with a mean age of 70.8 years. Bladder lesions were identified during TURP in 109 (21.2%) of the patients, and 90 of those lesions were submitted for pathological examination. The most common macroscopic finding was bullous edema, which was seen in 57 (63.3%) of the 90 lesions examined. The pathological analysis revealed chronic cystitis in 61 lesions (67.8%) and malignant lesions in 16 (17.8%). Of the 57 lesions described as bullous edema, 5 (8.8%) were found to be malignant. CONCLUSIONS: Alterations in the bladder mucosa appear to be more common among elderly patients who use an indwelling urinary catheter for a prolonged period and among patients with recurrent urinary tract infections. In addition, the risk of a bladder lesion being malignant is apparently higher in current and former smokers than in never smokers. Our findings suggest that at-risk patients should undergo biopsy or resection of incidental bladder lesions even if those lesions seem to be benign, due to the low level of agreement between the visual analysis and the pathological examination.

Dystrophic Calcification of the Bladder after Photovaporization of the Prostate with GreenLightTM Laser 180 W: A Case Report.

A 69-year-old patient who underwent photovaporization of the prostate (PVP) with GreenLightTM Laser presented chronic abdominal pain, in the following and after 7 months, an abdominal MRI showed a bladder mass and the cystoscopy revealed an 8 cm of diameter grayish mass of the anterior wall and the dome. Malignancy, infectious, and granulomatous diseases were ruled out. Biopsy showed necrotic tissue and dystrophic calcification (DC) with crystals and Gram-positive cocci, so a transurethral resection was intended failed due to the mass hard consistency and size. The patient was taken to partial cystectomy and the pain resolved. DC is defined as inappropriate deposits of calcium phosphate salts in previously damaged tissue by different forms of trauma: burns, radiotherapy, and surgery. We suggest the DC process is linked to a previous thermal lesion of the bladder during PVP and believe future studies of association can be relevant.

Large inguinal bladder hernias: can a preoperative diagnosis be made?

PURPOSE: Bladder hernias are asymptomatic in most cases and are found incidentally during exploration for inguinal hernia repair. The treatment of inguinal bladder hernia is either reduction or resection of the herniated bladder, followed by herniorrhaphy. We present a case series with preoperative diagnoses, along with their surgical outcomes. METHODS: We retrospectively reviewed the medical records from a single institution over a 5-year period (2012-2017) of five patients with diagnosis of large bladder inguinal hernia. Demographics, clinical status, medical history, anatomical structure of the hernia, and surgical outcomes were all analyzed. RESULTS: Patients' median age was 51 years (range 45-81 years). The median size of the hernial sac was 13 cm (range 8-20 cm). The diagnosis was made with computed tomography in three patients and with ultrasonography and cystography in two patients. Median length of hospital stay was 2 days (range 1-6 days), and median length of follow-up was 28 months (range 18-72 months). All patients continue to be alive and well, without hernia recurrence. The five cases are described separately along with their surgical managements. CONCLUSION: The main objectives in treatment of inguinal bladder hernia are to preserve the voiding function and to avoid bladder injuries in a tension-free hernia repair. To our knowledge, this is the first series of cases in which all inguinal bladder hernias were diagnosed preoperatively.

Bladder hematoma: a complication from an oocyte retrieval procedure.

INTRODUCTION: More than one million fertilization cycles are performed every year. The incidence of serious complications associated with transvaginal oocyte pick-up is low, but the procedure is not risk-free. Risks are inherent to procedures in which thin needles and sharp instruments are introduced into the vaginal wall and ovarian capsule to access the ovaries. CASE DESCRIPTION: A 45-year-old patient reported urinary discomfort and difficulty urinating after her second cycle, 12 hours after oocyte pick-up. She had visible hematuria with small blood clots. Transvaginal ultrasound examination performed 24 hours after pick-up showed a heterogeneous intravesical image suggestive of a clot; her bladder measured 23x19mm. She was afebrile and in good condition. The patient was managed conservatively and offered fluids. The clot was expelled within a matter of hours. This case of a bladder hematoma was the first in the 21 years of a clinic where all procedures are guided by ultrasonography with clear visualization of the tip of the needle throughout the 15-20 minutes of the procedure. Patients submitted to ultrasound-guided transvaginal oocyte pick-up procedures in IVF protocols must be informed of this rare potential complication.

Hydronephrosis Secondary to an Ectopic Decidual Reaction in the Urinary Bladder.

A 28-year-old pregnant woman at 19 weeks gestation presented with dysuria as well as lower abdominal and left flank pain. Imaging revealed left-sided hydronephrosis and a mass invading the posterior bladder wall. Management included placement of a left nephrostomy tube and transurethral resection of ~25% of the mass. Microscopy showed an ectopic decidual reaction within the muscularis propria. The patient improved symptomatically and continued prenatal care. Complete resolution of her ureteral obstruction was demonstrated during the postpartum period. Ectopic decidual reactions involving the urinary bladder are extremely rare, and ureteral obstruction secondary to this phenomenon has not yet been reported.

Diverticulitis vesical: reporte de un caso y revisión de la literatura / Bladder diverticulitis: case report and literature review

Se presenta un caso de diverticulitis vesical en un paciente de 60 años con antecedente de obstrucción crónica al tracto de salida vesical (estenosis uretral), quien consulta por dolor pelviano inespecífico. Por lo anterior se realiza Resonancia Magnética (RM) de pelvis, que demuestra la presencia de un divertículo vesical de pared engrosada con cambios inflamatorios, los que comprometen además, la grasa peri-vesical. Este divertículo había sido detectado en RM pelviana un año antes. Se comenta el caso clínico, sus hallazgos a la RM y revisión de la literatura...

We report a case of bladder diverticulitis in a 60 years old patient with a history of chronic lower urinary tract obstruction (urethral stricture), who consulted for nonspecific pelvic pain. Pelvic magnetic resonance imaging (MRI) was obtained, demonstrating the presence of a bladder diverticulum with a thick wall and inflammatory changes involving the perivesical fat. The diverticulum had been detected on pelvic MRI a year earlier. We discuss the clinical case, the MRI findings and a review of the literature....

Haga su diagnóstico / Make your diagnosis

El diagnóstico es: Síndrome megavejiga-microcolon-hipoperistaltismo intestinal: SMMHI

Haga su diagnóstico / Make your diagnosis

El diagnóstico es: síndrome megavejiga-microcolon-hipoperistaltismo intestinal: SMMHI

Hiperplasia de próstata y divertículo vesical congénito: presentación de un caso / Prostatic hyperplasia and congenital bladder diverticulum: a case report

Los divertículos congénitos en el adulto se detectan normalmente asociados a factores obstructivos a la salida vesical, se manifiestan mayormente por sepsisurinarias. Se presenta el caso de un paciente masculino de 69 años que asistió a consulta por nocturia, chorrofino, pujo, urgencia miccional y sensación de vaciamiento incompleto. Mediante tacto rectal se detectópróstata en grado I con asimetría discreta de la consistencia del lóbulo derecho en forma nodular que nose levantaba de la superficie; al examen físico se palpó masa tumoral en la región de hipogastrio, no dolorosa.El ultrasonido y la cistografía mostraron divertículo vesical gigante de cuello estrecho hacia la pared lateralderecha de la vejiga. Se confirmó mediante la cistoscopia y se procedió a la intervención quirúrgica. La histología reveló la existencia de capas mucosas, muscular y adventicia en su pared, corroborándose su origen congénito. El paciente evolucionó satisfactoriamente después de la operación quirúrgicos urológicos masculinos; obstrucción del cuello de la vejiga urinaria(AU)

Congenital diverticula in adults are typically associated with bladder outlet obstruction and their manifestation is most commonly by urinary sepsis. The case of a 69 years old male patient who attended consultation because of nocturia, thin urine stream, pushing, urgent urination and sense of incomplete emptying is presented. Through rectal examination grade I prostate with discrete grade I asymmetry consistent with right nodular lobe that did not rise to the surface was detected. During the physical examination tumor mass was palpated in the lower abdomen region. It was painless. Ultrasound and cystography showed giant bladder diverticulum with a narrow neck into the right lateral wall of the bladder. Cystoscopy confirmed the diagnosis and the patient was treated trough surgery. Histology revealed mucosal layers and muscle and adventitia in the wall, thus confirming congenital origin. Recovering after surgery was satisfactor(AU)

Schistosomiasis mansoni of the bladder simulating bladder cancer: a case report.

The relationship between bladder tumors and Schistosoma haematobium is well known, but only sporadic cases of bladder infection due to Schistosoma mansoni have been reported. In this case, a 48-year-old woman with macroscopic hematuria, dysuria and a palpable abdominal mass was investigated. Ultrasound showed a large exophytic mass in the bladder. Transurethral resection of the bladder revealed viable eggs of Schistosoma mansoni. The patient was treated clinically with oxamniquine and surgery was performed to resect the large mass. This case shows that schistosomiasis Mansoni in the bladder can simulate bladder cancer.

Schistosomiasis mansoni of the bladder simulating bladder cancer: a case report / Esquistossomose mansônica simulando câncer de bexiga: relato de caso

The relationship between bladder tumors and Schistosoma haematobium is well known, but only sporadic cases of bladder infection due to Schistosoma mansoni have been reported. In this case, a 48-year-old woman with macroscopic hematuria, dysuria and a palpable abdominal mass was investigated. Ultrasound showed a large exophytic mass in the bladder. Transurethral resection of the bladder revealed viable eggs of Schistosoma mansoni. The patient was treated clinically with oxamniquine and surgery was performed to resect the large mass. This case shows that schistosomiasis Mansoni in the bladder can simulate bladder cancer.

É bem conhecida a relação entre tumor vesical e Schistosoma haematobium, porém somente casos esporádicos de infecção vesical por Schistosoma mansoni foram relatados. Neste caso, uma mulher de 48 anos com hematúria macroscópica, disúria e massa abdominal palpável foi investigada, ultra-sonografia mostrou uma grande massa exofítica na bexiga. A ressecção transuretral de bexiga evidenciou ovos viáveis de Schistosoma mansoni. A paciente foi tratada clinicamente com oxaminiquine e uma cirurgia foi realizada para ressecar a grande massa. Este caso mostra que a esquistossomose mansônica vesical pode simular um câncer vesical.

Abdome agudo: ruptura espontânea de bexiga como um importante diagnóstico diferencial / Acute abdomen: spontaneous bladder rupture as an important differential diagnosis

A case of spontaneous perforation of the bladder in a diabetic female patient is reported. It is a rare clinical condition, that should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumor in the bladder. A general surgeon should be aware of this possibility in the differential diagnosis of an acute abdomen.

Accuracy of magnetic resonance imaging for diagnosis and preoperative assessment of deeply infiltrating endometriosis.

OBJECTIVE: To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) findings relative to surgical presence of deeply infiltrating endometriosis (DIE). METHODS: This prospective study included 92 women with clinical suspicion of DIE. The MR images were compared with laparoscopy and pathology findings. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI for diagnosis of DIE were assessed. RESULTS: DIE was confirmed at histopathology in 77 of the 92 patients (83.7%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI to diagnose DIE at each of the specific sites evaluated were as follows: retrocervical space (89.4%, 92.3%, 96.7%, 77.4%, 90.2%); rectosigmoid (86.0%, 92.9%, 93.5%, 84.8%, 89.1%); bladder (23.1%, 100%, 100%, 88.8%, 89.1%); ureters (50.0%, 100%, 95.5%, 95.7%); and vagina (72.7%, 100%, 100%, 96.4%, 96.7%). CONCLUSION: MRI demonstrates high accuracy in diagnosing DIE in the retrocervical region, rectosigmoid, bladder, ureters, and vagina.

[Acute abdomen: spontaneous bladder rupture as an important differential diagnosis]. / Abdome agudo: ruptura espontânea de bexiga como um importante diagnóstico diferencial.

A case of spontaneous perforation of the bladder in a diabetic female patient is reported. It is a rare clinical condition, that should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumor in the bladder. A general surgeon should be aware of this possibility in the differential diagnosis of an acute abdomen.

Rotura espontánea de vejiga urinaria post parto vaginal / Spontaneous rupture of urinary bladder

Antecedentes: La rotura de la vejiga en el post parto es una condición poco común y cuando ocurre se convierte en una emergencia que requiere un diagnóstico y tratamiento inmediato. Caso clínico: Paciente de 41 años, multípara de 4, se presenta al Servicio de Urgencia 4 días después del parto, con distensión abdominal progresiva asociado a oliguria y dolor abdominal de tres días de duración. Los exámenes de laboratorio revelaron presencia de marcada elevación de las concentraciones de urea y creatinina. La ecografía abdominal reveló la presencia de ascitis con hígado y riñones de aspecto normales. Las condiciones de la paciente empeoran y se decide efectuar laparotomía exploradora, encontrándose una lesión vertical en la cara posterior de vejiga de 5 cm, orina libre en abdomen y signos de peritonitis. Se efectúa sutura vesical. No se reconoce rotura uterina. Se retira sonda vesical al décimo día y es dada de alta con buena función vesical. Conclusión: La rotura espontánea de la vejiga urinaria post parto es extremadamente rara. Un diagnóstico temprano y la exploración inmediata disminuye la morbilidad y mortalidad en esta condición.

Background: Bladder rupture in an uncommon condition and when it occurs is converted in an emergency and require immediate diagnosis and treatment. Case report: A 41-year-old patient, IV para, assisted four days after vaginal delivery with progressive abdominal distention, associated with oliguria and abdominal pain of three days of duration. Laboratory showed the presence of a marked elevation of urea and creatinine concentrations. Abdominal ultrasonography revealed the presence of ascites with normal liver and kidneys. Patients conditions worsened and a laparotomy is done, where a 5 cm vertical lesion of bladder in his posterior face were found, with free urine in abdomen and peritonitis signs. Bladder was sutured. Uterine rupture is not recognized. Foley catheter was withdrawn to the tenth day and the patient was discharged with good bladder function. Conclusions: Postpartum spontaneous bladder rupture is extremely rare. Early diagnosis and immediate exploration diminish morbidity and mortality in this condition.

Recurrent urinary tract infections and bladder dysfunction in systemic lupus erythematosus.

To assess bladder function in systemic lupus erythematosus (SLE) patients with recurrent urinary tract infections (UTIs). A convenience sample of consecutive patients with SLE (American College of Rheumatology criteria), with recurrent UTIs (>/=3 events in the preceding 12 months), without history of central nervous system involvement, urolithiasis or preceding tuberculosis were studied. Disease activity (SLEDAI-2K), damage (SDI), lower urinary tract symptoms [Pelvic pain and Urgency/Frequency (PUF) and the Interstitial Cystitis Symptom and Problem Index (ICSPI) scales] and Autonomic Symptom Profile (ASP) were assessed. All patients underwent urological examination and urodynamic assessment with cystometry, uroflow, micturition and urethral pressure profile. Ten patients (nine women) were included. The majority of the patients reported urinary symptoms: urgency (n = 8), frequency (n = 8), nocturia (n = 9) and pain (n = 10). The patients had a mean (SD) ICSPI score of 18.4 (9.8), PUF score of 17.4 (5.3) and ASP weighted score of 31.7 (16.1). Abnormal urodynamics findings were identified in seven of the 10 patients, including small bladder capacity (two patients), reduced bladder sensation (four patients), subnormal urinary flow rate (one patient) and a significant amount of residual urine (two patients). The urodynamics findings suggest that bladder dysfunction could be one of the mechanisms involved on the occurrence of recurrent UTIs in patients with SLE. These findings have potential implications for the proper assessment and management of SLE patients with recurrent UTIs. Further studies are needed to corroborate our results.

New method for minimally invasive urodynamic assessment in men with lower urinary tract symptoms.

OBJECTIVES: Urodynamic studies are considered the reference standard to diagnose bladder outlet obstruction. However, the procedure is invasive, expensive, and time-consuming. The purpose of this study was to evaluate a new minimally invasive urodynamic assessment model and compare the results with those of conventional urodynamic evaluation. METHODS: The study included 50 male patients who presented with lower urinary tract symptoms. Their mean age was 62 years (range 34 to 82). After undergoing a conventional urodynamic study, they underwent the minimally invasive evaluation. The urethral device is a conical apparatus that adapts to the urethral meatus and fossa navicularis. The isometric bladder pressure and interrupted flow were recorded. The results of the conventional assessment were classified according to the Abrams-Griffiths number and a logistic regression fit was applied to the minimally invasive method. RESULTS: Only two variables demonstrated the predictive capacity: the isometric pressure and interrupted flow. In addition to selecting the relevant variables, logistic regression analysis is a more adequate model that provides a binary result of obstructed and unobstructed, used to predict the normal and equivocal categories of the Abrams-Griffiths classification, and taken as the reference standard. The sensitivity and specificity of the new method was 67% and 79%, respectively. CONCLUSIONS: The urethral device proved to be simple and easy to use. The minimally invasive method was able to detect most patients with bladder outlet obstruction; thus, the conventional urodynamic assessment could be avoided. We consider this method to have a place as a first-line noninvasive examination.