Benzalkonium chloride induced corrosive balanoposthitis in a man requiring clean intermittent catheterization.

INTRODUCTION: Men who require intermittent catheterization may be susceptible to balanoposthitis. Benzalkonium chloride is commonly used to disinfect reusable catheters, but the concentration of this solution is critical. CASE PRESENTATION: A 40-year-old man presented with fever, pus around the glans and foreskin, and difficult catheterization. On physical examination, his urethral meatus was too narrow to insert a catheter. Suprapubic catheterization and 2 weeks of intravenous and topical treatment cured the ulcer of the glans. However, after restarting catheterization, the ulcer of the glans relapsed, and the patient's urethral meatus was completely closed. Circumcision and incision of the meatus were performed, and antibiotics were administered. Unexpectedly, restarting catheterization caused recurrent balanoposthitis. Close inquiry revealed that the patient was using a 10% benzalkonium chloride soaking solution for a reusable catheter, which was a toxic concentration. CONCLUSION: The disinfectant concentration should be confirmed when refractory balanoposthitis is encountered in patients who require catheterization.

Transvesical Laparoscopic Surgery for a Stone in the Ureterocele.

Background: Ureteroceles containing stones present as a unique challenge to the urologist. When a calculus has to be removed from within the ureterocele, a large opening leads to de novo vesicoureteral reflux (VUR), which may result in recurrent infections and renal parenchymal damage. Case Presentation: We present a case of a 13-mm stone in the ureterocele in an 11-year-old boy. He was asymptomatic but presented with abnormal urinalysis results and unilateral hydronephrosis. To avoid de novo VUR, we performed minimally invasive transvesical laparoscopic ureterolithotomy, which included partially suturing the incision at the roof of the ureterocele so that a small opening is maintained for drainage of urine. The surgery was performed with no complications and with normal postoperative urinalysis results. The patient's hydronephrosis resolved, and postoperative voiding cystourethrography showed no VUR. Conclusion: Transvesical laparoscopic ureterolithotomy with partial suturing of the incision at the roof of the ureterocele is a good treatment option, particularly for asymptomatic patients.

The effects of chronic hyperlipidemia on bladder function in myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits.

AIMS: Lower urinary tract symptoms (LUTS) are common in the aging population. LUTS cause profoundly negative impacts on their quality of life. Pathophysiology of LUTS is multifactorial, and recently, bladder ischemia and metabolic syndrome have been suggested as etiological factors. To evaluate chronic hyperlipidemia on bladder function, we examined the functional and histological changes of the bladder in myocardial infarction-prone Watanabe Heritable Hyperlipidemic (WHHLMI) rabbits. METHODS: 20- to 24-month-old WHHLMI rabbits and age- and sex-matched control rabbits were prepared. Bladder functions were evaluated using cystometrograms and functional experiments with isolated bladder specimens. Histological studies of bladder and internal iliac arteries were performed with hematoxylin and eosin staining. The bladder was also stained immunohistochemically with mouse monoclonal S-100 antibodies and sheep polyclonal calcitonin gene-related peptide (CGRP) antibodies. RESULTS: In cystometric examination, WHHLMI rabbits showed significantly shorter micturition interval, smaller voided volume with non-voiding contractions, and lower micturition pressure, as compared to control. The functional experiments showed that carbachol- and electrical field stimulation-induced contractions were significantly decreased in WHHLMI rabbits than those in control. In WHHLMI rabbits, cross-sections of internal iliac arteries showed significant atherosclerosis and thickening of media. Bladder showed thinner urothelium and decreased smooth muscle area in WHHLMI rabbits, as compared to control. WHHLMI rabbits showed a significant decrease in S-100 protein positive neurons, and an increased number of CGRP positive neurons. CONCLUSIONS: This study demonstrated that WHHLMI rabbits showed detrusor overactivity with decreased detrusor contraction. It is suggested that chronic hyperlipidemia contributes to the bladder dysfunction.

Pharmacological effects of solifenacin on human isolated urinary bladder.

To investigate the effects of solifenacin on human detrusor smooth muscles, we evaluate the effects of solifenacin on the contractions induced by carbachol, KCl, CaCl2 and electrical field stimulation (EFS), and the EFS-induced acetylcholine release from detrusor smooth muscle strips by using the muscle bath and microdialysis technique. The effects of solifenacin were also compared with effects of other antimuscarinic agents (atropine, oxybutynin and propiverine). Pretreatment with various antimuscarinic agents caused parallel shifts to the right of the concentration-response curves to carbachol. The pA2 value of the Schild plots for solifenacin was similar to that for oxybutynin. Atropine did not inhibit the KCl- and CaCl2-induced contractions, while solifenacin, oxybutynin and propiverine significantly inhibited these contractions. EFS-induced contractions were inhibited by various antimuscarinic drugs in a concentration-dependent manner. In the presence of atropine, solifenacin tended to inhibit the residual atropine-resistant contractions induced by EFS, but it was not significant. However, oxybutynin and propiverine inhibited them under the same conditions. Although pretreatment with atropine and propiverine did not cause significant changes in EFS-induced acetylcholine release, solifenacin and oxybutynin caused significant decreases in acetylcholine release. The present results suggest that solifenacin inhibits contractions of human detrusor smooth muscles mainly by the antimuscarinic action and that the high concentration of solifenacin has Ca2+ channel antagonist action. Moreover, solifenacin may block not only postjunctional receptors, but also prejunctional receptors to modulate acetylcholine releases in cholinergic nerve endings in human detrusor smooth muscles. The findings support that muscarinic-receptor-inhibitory actions in human bladder mainly contribute to the usefulness of solifenacin as a therapeutic drug for overactive bladder.

[Bilateral pheochromocytomas with von Hippel-Lindau disease: a case report].

A case of bilateral pheochromocytomas with von Hippel Lindau disease (VHL) is reported. A 32-year-old man visited Kumamoto Red Cross Hospital for further examination of hypertension. Computed tomography revealed bilateral adrenal tumors and noradrenalin levels in serum and urine were elevated. Suspecting bilateral pheochromocytoma, he was reffered to our hospital for further examination and treatment. 131I-MIBG scintigraphy showed accumulation in bilateral adrenal glands. Moreover, he had cerebellar and spinal hemangioblastomas. Bilateral adrenalectomies and left nephrectomy were performed because tumor thrombus extended into the left renal vein, and pathological diagnosis was pheochromocytoma. His sister had been diagnosed as VHL disease. We diagnosed the patient as VHL disease because of the existence of cerebellar and spinal hemangioblastomas, bilateral pheochromocytomas, missense mutation and his family history. This is the eleventh case of bilateral pheochromocytomas with VHL disease reported in Japanese literatures.

Effect of tamsulosin hydrochloride on lower urinary tract symptoms and quality of life in patients with benign prostatic hyperplasia. Evaluation using bother score.

Benign prostatic hyperplasia (BPH) affects quality of life (QOL), and the goal of treatment is to improve lower urinary tract symptoms (LUTS), thus improving patient QOL. However, the international prostate symptom score (IPSS) used for evaluating LUTS does not always reflect the level of patient bother, and improvement in the IPSS score does not always reflect patient QOL. Therefore, in the present study, we observed the therapeutic effects of alpha(1)-blockers on IPSS, QOL index, and the bother score for individual symptoms. Ninety-three men diagnosed with BPH who had not yet been treated were enrolled (mean age 70 years). The IPSS, QOL index, and bother score for each symptom of IPSS (maximum 42 points, 7 grades, from 0 to 6: not at all bothersome, not bothersome, not much bother, neutral, a little bothersome, somewhat bothersome, very bothersome) were assessed in order to examine the correlation between LUTS and QOL. After treatment with tamsulosin hydrochloride 0.2 mg/day for 4 weeks, the change in each IPSS and bother score and the correlation was reassessed. Furthermore, the contribution of improvements in each symptom score and bother score to improvement in QOL index was examined using a path analysis model. On the IPSS at initial evaluation, the score was highest for slow stream. The bother scores were high for slow stream, nocturia, and daytime frequency. For slow stream, patients with a high IPSS score also had a high bother score, but for nocturia, there was a large discrepancy between the IPSS and bother score. After treatment, total IPSS, QOL and total bother scores were significantly improved (p <0.01). Improvements in all individual symptom scores and bother scores were also observed (p <0.01). The most predictable symptom for improvement in QOL after treatment was the improvement in the bother score for nocturia (F test; p <0.01). Treatment with tamsulosin hydrochloride showed significant improvement of each IPSS and the bother score. For nocturia, there was a large discrepancy between the IPSS and bother score. After treatment, the improvement in bother score for nocturia showed the strongest contribution to improvement in QOL. The present study suggests that in addition to the IPSS, the evaluation of bother score for each symptom may be necessary in the management for patients with LUTS suggestive of BPH.