CASE REPORT: TREATMENT OF UROLITHIASIS IN A PREGNANT MIXED BREED CAT

There is clear evidence that early causal therapy improves outcome in sepsis and septic shock, whereas recent studies on supportive hemodynamic therapy have produced very conflictive results. The objective of the present study was to determine whether a supportive hemodynamic therapy guided by clinically relevant invasive monitoring improves survival and organ function in a high-lethality model of septic shock in sheep as compared to sole causal therapy including surgical and antimicrobial treatment. Twenty healthy ewes were anaesthetized and instrumented for hemodynamic surveillance. After laparotomy and fecal withdrawal from the caecum, animals were randomly assigned to one of four groups: sham, control, causal and combined therapy. In all groups but the sham group, feces were injected into the peritoneal cavity. Septic shock was defined as mean arterial pressure (MAP) ≤60 mmHg and arterial lactate concentration ≥1.8 mmol·L-1. Animals of the control group received no therapy, while the causal group received broad-spectrum antibiotic therapy and peritoneal lavage. The combined therapy group received causal therapy plus supportive hemodynamic therapy. The sham animals showed no signs of systemic infection, while all other animals developed septic shock with arterial hypotension and lactic acidosis within 4.0 (4.0-6.8) hours. Induction of causal therapy did not impact on haemodynamics as compared to the control group. Notably, 50% of the control animals and none of the causal therapy animals survived the study. Combined therapy stabilized haemodynamics and improved organ function and survival as compared to control and causal therapy groups. The present data suggest that sole causal sepsis therapy without hemodynamic support worsens outcome even more than natural evolution of sepsis and combined causal and supportive therapy. This underlines the importance of early hemodynamic stabilization in parallel with antibiotic and surgical treatment of the sepsis focus.

Electron microscopic observations on the collapsed and distended mammalian urinary bladder (transitional epithelium)

Management of Urinary Retention: Rapid Versus Gradual Decompression and Risk of Complications

Urinary schistosomiasis (US) is a burden in sub-Saharan Africa prevalently in Nigeria, and caused by a fluke called Schistosoma haematobium. This has a prevalence for the male gender and predominantly seen in children and adolescent. This is a 45-year-old farmer that was referred for pelvic radiograph and abdominal ultrasonography on account of recurrent right loin pain, dysuria and occasional terminal hematuria. The pelvic radiograph showed collapsed linear concentric rims of calcific densities in the region of the pelvic cavity centrally most likely a calcified, contracted and empty urinary bladder. The abdominal ultrasonogram demonstrated a urine distended urinary bladder with wall thickening of about 10mm more marked right laterally where a mucosal out-pouch and thickening of about 15.4mm was noted in its cranial aspect. There is associated right hydroureteronephrosis with enlarged right kidney, thinning of the cortical mantle and an echogenic focus in the lower calyceal moiety without acoustic shadow most likely a granuloma. An excretory pyelogram showed contrast excretion in both kidneys, moderate-severe dilatation of the right pevicalyces, dilated and tortuous contrast filled right ureter that had bulbous termination of part of the distal portion with non-demonstration of the remaining distal aspect most probably from fibrosis/stricture on account of schistosomiasis. The left collecting system and ureter were not dilated, though the distal left ureter appeared laterally deviated/curved simulating the left-lateral aspect of the so-called cow-horn appearance of schistosomiasis. A diagnosis of urinary schistosomiasis was made more marked on the right, the patient was placed on oral praziquantel with adequate monitoring and advice. We report a case of urinary schistosomiasis in a 45-year-old farmer, features of which were demonstrated following multiple imaging modalities.

Objective To investigate the effects of different frequency bladder irrigation on urinary tract infection and catheter colonization in patients with long-term indwelling urinary catheter and to select ideal irrigation frequency,so as to reduce infection.Methods Two hundred and seventy-five patients with long-term indwelling catheterization were randomly divided into 4 groups:group A (n =67) had bladder irrigation twice a day,group B (n =69) had bladder irrigation once a day,group C (n =70) had bladder irrigation twice a week,and group D (n =69) had no bladder irrigation at all.All the patients in the former 3 groups had exactly the same mode of bladder irrigation.After 3,7,14 and 21 days of catheterization,incidence rates of urinary tract infection for the four groups were statistically analyzed,and at day 21 bacterial isolation and culture in the midstream urine were performed and colony counting was recorded.Results At days 3,7,14 and 21,rates of incidence for the patients in group A were respectively 2.99％,10.45％,16.42％ and 35.82％ ; rates of incidence for the patients in group B were 0,10.14 ％,20.29％ and 33.33％ ; those for the patients in group C were 0,2.86 ％,10.00％ and 17.14％ and those for the patients in D group were 0,10.14 ％,23.19％ and 40.58％.No significant differences could be seen in the rates of incidence among the patients of the 4 groups after 3 days of treatment (P ＞ 0.05).After 7,14 and 21 days of treatment,incidence of urinary tract infection in the patients of group C was significantly lower than that of the other groups,while incidence for the patients in group D was significantly higher than that of the other groups (P ＜ 0.05).Colony counting of Escherichia coli,proteus,Klebsiella,Streptococcus faecalis and other pathogens in the patients of group C were (9.38 ±0.87),(6.33 ±0.54),(4.97 ±0.38),(2.12 ± 0.24) and (0.92 ±0.06) respectively,which were significantly lower than that of the other 3 groups (P ＜ 0.05).Conclusions Bladder irrigation could effectively reduce the incidence of urinary tract infection in patients with long-term indwelling catheterization,and frequent irrigation in our opinion was no good.With bladder irrigation twice a week,incidence rate of urinary tract infection for the patients with long-term indwelling catheterization was significantly lower than that of other patients,and it was indicated that irrigation twice a week was a more appropriate irrigation frequency. Key words: Bladder irrigation; Catheterization; Urinary tract infections; Bacterial colonization

Objective To evaluate the effect of modified transurethral bladder neck incision in treatment of female bladder neck obstruction. Methods Sixteen female patients with bladder neck obstruction from March 2008 to May 2016 in Beijing Haidian Hospital were selected, and the patients were treated with modified transurethral bladder neck incision at the 3, 6 and 9-O′clock positions. The international prostate symptom score (IPSS), quality of life (QOL) and maximum urinary flow rate (Qmax) were evaluated before surgery and 1 year after surgery respectively. Results All 16 patients underwent successful operation, and the mean operation duration was 20 min, with the blood loss<10 ml. The difficulty of urination after removing the catheter was significantly improved. Postoperative pathological results were chronic inflammatory changes with fibrous tissue proliferation. There was no complication such as urinary incontinence, vesico-vaginal fistula and urethral stricture after operation. The IPSS, QOL and Qmax after surgery were significantly improved compared with those before surgery: (6.43 ± 3.31) scores vs. (25.21 ± 4.71) scores, (1.41 ± 1.15) scores vs. (4.43 ± 1.36) scores and (15.36 ± 4.82) ml/s vs. (7.49 ± 2.27) ml/s, and there were statistical differences (P<0.01). Conclusions The modified transurethral bladder neck incision is a safe and effective therapy for female bladder neck obstruction. Key words: Urinary bladder neck obstruction; Transurethral incision of bladder neck; Female

Summary A 6-year-old male crossbred dog was referred to the Veterinary Medical Teaching Hospital of Islamic Azad University of Karaj with the history of abdominal distention, rectal tenesmus and stranguria. Abdominal radiographs and ultrasonography indicated large distended urinary bladder and prostatic enlargement. ECG showed temporary episodes of atrial standstill. The only abnormalities detected by serum biochemical analysis were mild uraemia and hyperkalaemia. The cause of hyperkalaemia and mild uraemia was postrenal azotaemia which was occurred as a consequence of bladder outlet obstruction secondary to prostatic enlargement. There was a good response to castration as a choice of treatment. Gradual improvement in the signs of rectal tenesmus and stranguria was observed over a period of three weeks following castration. Furthermore, ECG records during post-surgical period were normal.

IntroductionA distended urinary bladder has been known to cause venous obstruction or rarely bowel obstruction. We report the first case in the literature in which urinary bladder distension presented with both venous obstruction and constipation. This is an unusual presentation of urinary bladder distension and serves to broaden our differential diagnoses for a patient with clinical venous obstruction.Case presentationAn 83-year-old man of African descent presented with constipation and bilateral lower limb edema. A huge abdominal mass was evident which was a large, distended urinary bladder confirmed by computed tomography. Promptly after urethral catheterization, both constipation and lower limb edema resolved.ConclusionsTo the best of our knowledge distended urinary bladder causing both constipation and lower limb edema has never previously been reported. Analysis of the literature revealed several factors resulting in the patient's presentation. A high level of suspicion for urinary bladder distension must be maintained for prompt diagnosis and to avoid improper management.

To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT). PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy. The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis. Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death. Frequent findings in cases of fatal opioid intoxication were investigated. Lung oedema, brain oedema and full urinary bladder represent a highly specific constellation. This combination of findings in post-mortem CT should raise suspicion of intoxication.

Objective To evaluate the effect of electrical stimulation of the pelvic floor muscles combined with bladder training on urinary dysfunction after incomplete spinal cord injury. Methods Sixty-two incomplete spinal cord injury patients who had received an operation between November 2009 and December 2014 were enrolled and divided randomly into a control group (n=32) and a treatment group (n=30). Both groups were treated with conventional intermittent catheterization, while the treatment group was additionally given electrical stimulation of the pelvic floor muscles combined with bladder training. The residual urine volume was recorded before and after the treatment. Uurodynamic examinations were conducted, and the rate of successful catheter extraction and of urinary tract infection on the 15th and 30th day of treatment, were recorded and analyzed. Results All of the patients were followed-up for an average of 18.5 months. Significant improvement was observed in the residual urine volume, the maximum or average urinary flow rate, and the detrusor pressure at peak flow of both groups. However, at the end of follow-up the treatment group recorded significantly better results on all these measures than the control group. The successful catheter extraction rate of the treatment group (96.7%) was significantly higher than that of the control group and their average number of catheterization days was significantly fewer. The urinary tract infection rates on the 15th and 30th day of treatment were 16.7% and 6.7% in the treatment group, significantly lower than in the control group. Conclusions Electrical stimulation of the pelvic floor combined with bladder training significantly improves urination function after an operation for incomplete spinal cord injury, decreases the days of catheterization and lowers the rate of urinary tract infection. Such combined therapy is worth promoting in clinical practice. Key words: Electrical stimulation; Bladder training; Spinal cord injury

After completing this article, the reader should be able to: 1. Differentiate genitourinary abnormalities associated with hydronephrosis detected on fetal ultrasonography. 2. Describe the type of fetal hydronephrosis that requires a complete uroradiologic evaluation. 3. Characterize the complete postnatal uroradiologic evaluation of significant fetal hydronephrosis. 4. Delineate the factor that sets the timetable for postnatal uroradiologic evaluation. 5. Describe the neonates for whom diuretic renography is reserved. Ultrasonographic detection of antenatal anomalies in the fetus has increased steadily since its initial widespread use in the 1970s. During these early years, antenatal ultrasonography detected structural abnormalities in approximately 1% to 3% of all pregnancies. (1) Currently, it is estimated that genitourinary anomalies comprise 20% of all antenatally detected fetal anomalies. (2) In a recent British population-based study, fetal genitourinary anomalies were identified in 2.3% of women undergoing routine obstetric ultrasonography between 18 and 23 weeks of gestation. (3) Hydronephrosis clearly has become the most commonly detected antenatal anomaly on fetal ultrasonography. Detection of antenatal dilation of the urinary tract does not always indicate postnatal urinary tract obstruction or even a significant genitourinary anomaly. (4) Among infants diagnosed as having prenatal hydronephrosis or other genitourinary anomalies, the question often is raised about the need for and extent of the postnatal evaluation to assess the magnitude of this commonly detected antenatal anomaly. The purpose of this review is to provide a framework for assessment and management of antenatally detected hydronephrosis. Fetal hydronephrosis is a nonspecific finding that can be associated with multiple congenital anomalies of the genitourinary tract. A thorough understanding of disorders that can result in hydronephrosis postnatally allows the physician to assess the need for postnatal diagnostic tests and guide treatment recommendations. The congenital anomalies that may result in hydronephrosis can be categorized as disorders of urinary reflux and disorders of urinary obstruction. It can be …

Persistent pseudomembranous cystitis associated with Vagococcus lutrae in a setter dog: First clinical report.

Signet ring cell carcinoma is a rare variant of primary adenocarcinoma of the urinary bladder. Its histologic feature is a high mucin content in the cytoplasma; this compresses the nuclei to one side and brings about signet-ring appearance. The clinical course is fatally fulminant with diffuse invasion and early metastasis. This report concerns a 70-year old female who complained of difficulty in urination and with urinary retention. The image studies, including ultrasound, IVU (intravenous urography) and CT (computerized tomography) scan, showed a tumor mass over the bladder base eith the appearance of indenting prostate. Radical surgery (anterior exenteration) followed by adjuvant chemotherapy was performed. The final pathologic diagnosis was non-urachal, pure, invasive signet wing cell carcinoma of bladder with sgage P4N2MO. The patient remained well during a six-month follow-up. The literature is reviewed.

“Radiographic and Ultrasonographic Evaluation of Urinary System Affections in Dogs” was conducted on clinical cases of dogs of either sex from October 2023 to October 2024. Out of 1735 cases, 71(4.09%) had urinary system affections. Among the 71 cases, urinary bladder affections (56.33%) were more common followed kidney affections (28.16%), both bladder and urethra involvement (11.26%) and ureteral involvement (4.22%). Different urinary system diseases observed were cystic calculi (35.21%) followed by CKD (28.17%), cystitis (16.90%), obstructive urolithiasis (11.27%), TCC (4.23%) and ureter anomaly (1.41%). Breed wise highest incidence was recorded in Non-Descript dogs (23.94%). Age wise highest incidence was reported in dogs aged between 7 to 12 years (32 cases, 45.07%). Male dogs (56.33%) were more affected than females (43.66%). Clinical symptoms observed in urinary system affections were dribbling of urine, straining, hematuria, stranguria, vomiting, abdominal pain, depression, lethargy, anorexia, polyuria, and polydipsia and distended urinary bladder.

A young female presented with an acute abdominal pain and oliguria for 1 week following normal vaginal delivery. No history of hematuria was present. Patient was having lochia rubra. Sealed uterine rupture was suspected clinically. Initial ultrasound of the patient showed distended urinary bladder containing Foley catheter ballon with clamping of Foley catheter and particulate ascites. Abdominal paracentesis revealed hemorrhagic fluid. Contrast-enhanced computed tomography of abdomen revealed ascites, distended urinary bladder and no extraluminal contrast extravasation in delayed scan. As patient condition deteriorated, repeat ultrasound guided abdominal paracentesis was done which revealed transudative peritoneal collection with distended bladder. Cystoscopy revealed urinary bladder ruptures with exudate sealing the rupture site. Exploratory laparotomy was done and a diagnosis of extraperitoneal bladder rupture was confirmed. The rent was repaired in layers. She was put on continuous bladder drainage for 3 weeks followed by bladder training. It presented in a unique way as there was hemorrhagic peritoneal tap, no macroscopic hematuria and urinary bladder was distended in spite of urinary bladder wall rupture which delayed the diagnosis and treatment. Complete emptying of urinary bladder before second stage of labor and during postpartum period with perineal repair is mandatory to prevent urinary bladder rupture.