Intravesical encrusted gossypiboma mimicking bladder stone: A case report and review of the literature

Sir, Thyroid dysfunction is a common problem, especially among women. Thyrotoxicosis is characterized by exaggerated responses to catecholamines, while in hypothyroidism, narrowing of adaptive responses is observed. It is, therefore, not surprising to see gastrointestinal and lower urinary tract symptoms (LUTS) in patients with thyroid dysfunction. Unfortunately, published articles addressing voiding dysfunction in hyper-and hypothyroidism are scarce, most of them being case reports. In June 2012, we searched PubMed, Google Scholar, EMBASE, and Ovid for articles about these issues. The obtained results are as follows. Most hypothyroid patients are middle-aged women. They may develop retention of urine and renal failure.[1] This retention could be the presenting symptom or may be found incidentally in a patient who has other signs and symptoms of hypothyroidism like myxedema, malaise, a change in the tone of voice, and mental confusion.[2] Paralytic ileus (colonic pseudo-obstruction) has been reported in association with bladder atony in the setting of hypothyroidism.[1,2] Uremia may ensue as the result of urinary retention or acute kidney injury.[3] In less severe cases, only a reduction in the voiding frequency and urine volume is observed without bothering the patient.[4] Hyperthyroidism is also more common among women. Patients may exhibit both irritative and obstructive LUTS.[4] Of the LUT symptoms, urinary frequency is the most common.[4,5] Other storage symptoms include urgency, urge incontinence, nocturia, and enuresis (either primary or secondary).[4,6] Of the voiding symptoms, incomplete emptying and straining have been reported.[4,5] Patients rarely complain of urgency, frequency, and enuresis; therefore, they should be asked about these symptoms in moderate to severe cases of hyperthyroidism.[4] Urodynamic study has been performed in a few cases and the findings include: Diminished flow rate, increased post-void residue, increased pelvic floor activity during voiding,[5] early first sensation, and detrusor overactivity.[6] Bladder capacity has been reported to be normal, decreased,[6] or increased.[5] In a study, although the peak flow rate was significantly less than the control group, it was still in the normal range.[4] Chung and colleagues followed up some 11,000 female hyperthyroid patients for 3 years and found that the risk of developing urinary incontinence in them was more than in the healthy, control group (hazard ratio = 1.54).[7] Bladder involvement may be the presenting symptom or may appear a few months after the onset of the thyroid disease and is responsive to proper medical therapy. However, complete improvement may take several weeks to a few months. To better define the manifestations of bladder involvement in thyroid dysfunction, larger cohort of patients with thyroid problems should be evaluated for LUTS and urodynamic study be performed when indicated. Also, the incidence of thyroid dysfunction in patients presenting with LUTS should be determined.

BackgroundSpondyloarthritis (SpA) is a group of chronic inflammatory rheumatic diseases that can present with diverse extra-articular manifestations. However, bladder involvement as the primary clinical presentation has not been previously reported.Case presentation: We present a case report of a 55-year-old male with a 20-year history of recurrent left lower abdominal pain and lower urinary tract symptoms (LUTS). Despite multiple treatments for presumed chronic prostatitis and cystitis, symptoms persisted. Imaging revealed bladder wall alterations and inflammatory changes in bilateral sacroiliac joints. Laboratory tests showed positive HLA-B27 expression. Histopathological examination of bladder tissue demonstrated chronic inflammation with eosinophilic infiltration and vasculitis. These findings led to a diagnosis of SpA, despite the absence of typical musculoskeletal symptoms. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor (TNF) inhibitors resulted in complete resolution of urological symptoms and normalization of bladder morphology. After one month of continuous management, the patient experienced significant relief from left lower abdominal pain (NRS 2–3) and LUTS. The patient reported complete alleviation of pain (NRS 0) and LUTS at the three-month follow-up. No recurrence was observed during a 1-year follow-up period.ConclusionsThis case highlights the potential for SpA to manifest primarily with urological symptoms, emphasizing the need for clinicians to consider systemic inflammatory conditions in cases of refractory LUTS. The successful diagnosis and management underscore the importance of interdisciplinary collaboration between urology and rheumatology.

Purpose: Bladder involvement in the disease course of systemic lupus erythematosus (SLE) is uncommon; in fact, it has been shown that patients with SLE have lower urinary tract symptoms (LUTS) than the general population. This study aimed to identify LUTS and the relationship between LUTS and disease activity among women with SLE.Methods: This cross-sectional study used structured self-administered questionnaires. We recruited 110 women with SLE from the outpatient clinic of a university hospital between January and August of 2020. LUTS was assessed using the International Prostate Symptom Score, and disease activity was assessed using the Systemic Lupus Activity Questionnaire.Results: Fifty-seven women (51.8%) reported urinary incontinence (UI), while 53 (48.2%) reported no UI. The mean LUTS score was 7.75 ± 5.74 (range 0-35). The scores for the seven LUTS components (range 0-5) were as follows: frequency (1.51 ± 1.48), nocturia (1.46 ± 1.07), urgency (1.27 ± 1.35), incomplete emptying (1.09 ± 1.15), intermittency (0.97 ± 1.27), weak stream (0.94 ± 1.04), and straining (0.51 ± 0.91). LUTS were positively correlated with the disease activity of SLE (r = .48, p < .001), indicating that higher LUTS scores were associated with severe disease activity.Conclusion: The prevalence of UI was high, and LUTS (frequency, nocturia, and urgency) were common. Therefore, regular assessment and appropriate management of UI and LUTS among women with SLE are necessary, and it is also essential to keep the disease activity of SLE at a low level due to the positive relationship between disease activity and LUTS.

To review the efficacy of phosphodiesterase-5 (PDE-5) inhibitors for the treatment of lower urinary tract symptoms in men. MEDLINE and International Pharmaceutical Abstracts were searched (1970-August 2007) using the terms phosphodiesterase inhibitor, sildenafil, vardenafil, tadalafil, lower urinary tract symptoms, and benign prostatic hypertrophy. English-language clinical trials, case reports, and background material were evaluated for safety and efficacy data. References of reviewed articles were examined and used to identify additional sources. Erectile dysfunction (ED) and lower urinary tract symptoms have numerous shared risk factors and are common in aging men. PDE-5 inhibitors may relax urinary tract smooth muscle tissue, which has led to interest in their utility for lower urinary tract symptoms. Six 12 week clinical trials were identified. Three uncontrolled trials (N = 168) examined the effects of on-demand sildenafil ED dosing on lower urinary tract symptoms. The 2 largest trials found that, the greater the ED response, the larger the reduction in lower urinary tract symptoms. A single prospective placebo-controlled trial (N = 369) studied sildenafil 100 mg daily in men with ED and lower urinary tract symptoms. Lower urinary tract symptoms improved significantly in the sildenafil group; patients with the worst lower urinary tract symptoms experienced the greatest benefits. An open-label trial (N = 62) compared daily sildenafil 25 mg, alfuzosin 10 mg, or sildenafil 25 mg plus alfuzosin 10 mg on ED and lower urinary tract symptoms. Combination therapy resulted in greater improvements in ED and lower urinary tract symptoms and urinary flow than did either drug alone. The effects of daily tadalafil 20 mg were studied in 281 men with lower urinary tract symptoms independent of ED. Tadalafil produced statistically significant but clinically modest improvements in lower urinary tract symptoms when compared with placebo. PDE-5 inhibitors consistently produced modest reductions in lower urinary tract symptoms. Further studies are needed to fully elucidate the efficacy, cost effectiveness, safety, and appropriate place in therapy of PDE-5 inhibitors. At this time, data are insufficient to routinely recommend chronic use of PDE-5 inhibitors for lower urinary tract symptoms in men.

This case report is about an atypical incarcerated right-sided inguinoscrotal hernia with bladder involvement and secondary urinary incontinence in a male in his mid-70s. The patient had no lower urinary tract symptoms but underwent a herniotomy, revealing bladder involvement. Post-surgery showed no signs of urinary incontinence, and most probably bladder distortion caused continuous urine seepage. Inguinoscrotal hernias with bladder involvement are rare and usually asymptomatic. CT scans can diagnose bladder involvement preoperatively.

Summary Medical records of 3 cats and 72 dogs that had a fishhook endoscopically or surgically retrieved from the stomach or esophagus were reviewed. Endoscopic retrieval was successful in 41 of 62 (66%) animals, and retrieval time and hospitalization time for endoscopic retrieval were significantly shorter than times for surgical retrieval. Rate of failure of endoscopic retrieval was higher for animals with treble-barb, rather than single-barb, fishhooks. Whether a fishhook could be successfully retrieved endoscopically was independent of body weight, amount of time the fishhook had been present, location of the hook, and orientation within the esophagus.

Ectopic tissue is rarely found in the bladder for adults. Currently, there have been reports of ectopic prostate and colon tissue in the bladder. These ectopic tissues are manifested as a bladder mass and cause lower urinary tract symptoms. However, the ectopic corpus cavernosum in the bladder has never been reported, and its clinical characteristics and treatment have not been explored yet. A 3-year-old boy was admitted to the hospital due to 1 month of urinary frequency. The physical examination was unremarkable. Urine analysis from other hospitals showed an elevated urine white blood cell count of 17.9/ul. In addition, ultrasound indicated a possible bladder mass. CT and MRI showed a well-margined lesion (1.9×1.9 cm) in the bladder trigone. Through preoperative imaging, we diagnosed a bladder tumor (inclined towards benign). The transurethral resection of the bladder tumor was performed. Unfortunately, the surgery was unsuccessful due to the difficulty in removing the excised tissue through the urethra. Subsequently, bladder incision and tumor resection were performed. The tumor was successfully removed. Surprisingly, the postoperative pathology showed that the tumor tissue was corpus cavernosum. The pathological diagnosis was ectopic corpus cavernosum in the bladder. No complications were found after the operation, and no recurrence was observed during follow-up. The ectopic corpus cavernosum in the bladder has never been reported for children, which is presented as a benign tumor with rapid proliferation and large size. Surgery is recommended. However, the transurethral resection of bladder tumors is difficult to perform due to narrow urethra and limited surgical instruments. Bladder incision and tumor resection may be preferred.

Treatment Outcomes of Lower Urinary Tract Symptoms due to Fragility Sacral Fractures: A Review of Eight Patients and Literature

BackgroundAccidental foreign body ingestion is a common phenomenon in children between 6 months to 6 years of age. In adults, foreign body ingestion is commonly observed in the geriatric population and in patients with psychiatric disorders. Over 80% of ingested foreign bodies pass uneventfully through the intestinal tract. Endoscopic retrieval is needed in about 20% while surgical intervention is indicated in less than 1%. Herein we report an extremely rare case of esophagocutaneous fistula following operative retrival of an impacted denture in the esophagus with spontaneous healing within 3 weeks. A similar case to the best of our knowledge has so far not been reported previously.Case presentationA case of accidental ingestion of a dental prosthesis in a 35-year old schizophrenic patient is presented. The patient was referred to our department after accidentally swallowing one of his dental prosthesis. Surgical retrieval was indicated after two unsuccessful endoscopic retrieval attempts. The denture was retrieved following a longitudinal incision of the esophagus via a left cervical approach. The postoperative course was complicated by a clinically suspected esophagocutaneous fistula which was managed conservatively via nothing per os with enteral feeding via a nasogastric tube. Secretion ceased 3 weeks later and a fistula could not be found on contrast enhanced radiographic examination with gastrographin®.ConclusionEsophagocutaneous fistula represents a rare but serious complication following foreign body ingestion. An interdisciplinary management including an early surgical consultation should be considered in patients with foreign body impaction in the esophagus following failure of endoscopic retrieval.

Intrauterine contraceptive devices (IUCDs) are widely used, effective, and reversible, but rare complications include uterine perforation with extrauterine migration. Intravesical migration is uncommon and may serve as a nidus for vesical calculus formation, presenting with persistent lower urinary tract symptoms (LUTS) that are often misattributed. Objective: To describe the presentation, diagnostic pathway, and endoscopic management of an intravesically migrated IUCD with secondary bladder calcifications, emphasizing key follow-up and imaging considerations. Methods: This single-patient case report was conducted in the Department of Urology at Dr SAM CHB. The observation period spanned the index urology evaluation through a 1-week postoperative follow-up. The clinical data included a comprehensive history, a thorough examination, and relevant imaging studies. The diagnostic work-up consisted of a plain X-ray of the kidneys, ureters, and bladder (KUB), which revealed a metallic foreign body projected over the bladder, and ultrasonography, which demonstrated intravesical calcifications. The patient underwent diagnostic cystoscopy followed by same-session cystoscopic extraction of the IUCD with removal of adherent calcifications. Peri-operative outcomes and early symptom resolution were recorded. No statistical analysis was applicable due to the single-case design. Results: A 32-year-old woman with a 4-year history of dysuria, frequency, urgency, and intermittent fever had an IUCD inserted 5 years earlier that was presumed expelled after abnormal uterine bleeding; she subsequently conceived and delivered vaginally, with LUTS persisting postpartum. X-ray KUB identified a T-shaped metallic foreign body within the pelvis consistent with an IUCD; ultrasound confirmed intravesical calcifications. Initial management elsewhere was planned as an open cystolithotomy for presumed primary vesical calculus. On referral, cystoscopy revealed a partially encrusted IUCD within the bladder. Complete endoscopic removal of the IUCD and attached calcifications was achieved in a single session without complications. At 1-week follow-up, the patient reported complete resolution of LUTS. Conclusion: Intravesical IUCD migration, though rare, should be considered in women with unexplained LUTS and a history of IUCD insertion, especially when expulsion is suspected. Early use of plain radiography and targeted cystoscopy can expedite Diagnosis and enable minimally invasive, single-stage endoscopic removal, avoiding unnecessary open surgery. Routine post-insertion follow-up and prompt imaging when strings are not visualized or expulsion is suspected are essential to prevent delayed morbidity.

Background: Lower urinary tract symptoms (LUTS) are complaints that characterized by two symptoms, an overreactive symptoms such as frequency and urgency, and outlet obstruction symptoms such as difficulty urinating and weak urinary flow. Neurologic diseases such as diabetes mellitus are well-known causes of LUTS, however LUTS secondary to an intracranial mass lesion has been very rarely described in the literature. Case Report: 52-year-old woman came to Neurology outpatient clinic with difficulty in communicating. The patient's family said that the patient often did not connect to talk for approximately 3 months. Patients also often wet in the bed in the last 1 month. CT Scan with contrast revealed intracranial lesions in the right frontal lobe and diffuse brain edema, most likely high-grade astrocytoma Discussion: Lower urinary tract symptoms (LUTS) are very common in men. There are many causes of LUTS, such as neurologic, anatomic, inflammatory, infection, psychogenic, and idiopatic. Intracranial tumors rarely cause LUTS, but the pathophysiology is clearly known. Andrew and Nathan were the first researchers to report a frequency, urgency, and urinary incontinence syndrome that caused mass in the frontal lobe and anteromedial parts of the frontal lobes including the cingulate girus in 1964. Maurice-Williams also reported a serial case in which 7 of 50 patients with tumors the frontal lobe is associated with LUTS. Conclusion: Frontal lobe mass are an uncommon cause of LUTS. If the person with LUTS has no known cause, then the neurological cause must be considered. Symptoms such as bradypsychia (slowness of thought or mental activity), decreased motivation, and intracranial mass symptoms must be considered in order to determine the cause of LUTS.

Objective: Bladder tumor antigen (BTA) is a common biomarker for urothelial carcinoma while bladder wall thickening (BWT) is a sign of urinary bladder irritation which suggests cystitis or early-stage bladder cancer pathology, most especially in the absence of bladder outlet obstruction. The aim of this study was to find the incidence of urinary bladder thickness and evaluate the relationship between BTA and BWT in a low schistosomiasis-endemic Nigerian village. Materials and Methods: The study was descriptive and cross-sectional. Freshly passed mid-day urine samples of 56 individuals were screened using chemical reagent strips and then diagnosed microscopically for Schistosoma haematobium. Subsequent follow-up involving ultrasound examination was carried out on distended bladder. The lower urinary tract symptoms (LUTS) were also recorded. Urinary BTA analysis was carried out on the urine samples using enzyme-linked immunosorbent assay. Results: The prevalence of urogenital schistosomiasis in the area was 3.6%. The overall prevalence of human BTA and BWT in the individuals was 44.6 and 35.7%, respectively. The LUTS were associated with BWT (P = 0.004; odds ratio = 6.0; 95% confidence interval = 1.8–20.3). BTA, BWT, and LUTS were not sex and age dependent (P > 0.05). In addition, there was no association between urinary BTA, BWT, and LUTS (P > 0.05). The sensitivity of BWT and LUTS (60.0%) was improved than when either was used to diagnose BTA. Conclusion: The high occurrence of BTA and BWT in the individuals suggests that they may be prone to urothelial carcinoma and urinary bladder irritation, respectively. The role of urogenital schistosomiasis in urinary BTA levels needs to be further explored.

Urogenital tuberculosis (UGTb) is the second most common form of extrapulmonary Tb. We aimed to evaluate the clinical consequences in our 20-year experience of UGTb. We retrospectively reviewed the files of consecutive patients diagnosed with UGTb through microbiological methods between January 2001 and April 2021 in our centre. Clinical and demographic data of the patients were assessed. Surgical procedures during the disease course were also noted. A total of 46 patients (26 males) having a median age of 48.5 (16-82) years were diagnosed with UGTb. The most frequent complaint at admission was lower urinary tract symptoms (LUTS), followed by nonspecific symptoms, macroscopic hematuria, flank pain, scrotal swelling, and infertility. A history of pulmonary Tb was present in 10 patients. The kidney was the most affected organ, followed by ureter, bladder, and testis/epididymis. Bladder involvement and admission with LUTS was significantly higher in elderly patients (≥60 years), whereas the rate of nonspecific symptoms was significantly higher in younger patients (≤40 years). Eleven patients required surgical interventions including nephrectomy (n = 5), nephroureterectomy (n = 2), orchiectomy (n = 1), epididymectomy (n = 1), distal ureterectomy + ureteroneocystostomy (n = 1), and epididymovasostomy (n = 1). Among the 32 patients with at least 12 months of follow-up (median 114 months, range: 12-180) four had ongoing LUTS, 5 had chronic kidney disease, one had end-stage renal disease, and one had azoospermia. UGTb affected the upper urinary tract with a fair chance of renal function deterioration in addition to LUTS and infertility. These conditions may impair the patient's long-term quality of life. Elderly patients were also more prone to bladder involvement, and approximately one-quarter of patients with UGTb required surgical intervention.

Duloxetine treatment of long-term ketamine abuse-related lower urinary tract symptoms: a case report

To assess the risk of acute urinary retention with the use of inhaled anticholinergic agents in men with lower urinary tract symptoms (LUTS) or benign prostatic hyperplasia (BPH). A literature search was performed with MEDLINE via PubMed from 1967 through May 2012 using the terms inhaled anticholinergics, urinary retention, benign prostatic hyperplasia, lower urinary tract symptoms, tiotropium, and ipratropium. In addition, references from reviewed publications were identified and official labeling was obtained from the manufacturers' Web sites. Only English-language publications were included. Randomized controlled trial data, observational studies, case reports, package labeling, and commentaries regarding men with BPH/LUTS using inhaled anticholinergic agents and the associated development of urinary retention were reviewed. Two case reports; 1 prospective, open-label, single-arm study; and 2 nested case-control studies evaluated or described the use of inhaled anticholinergic agents and the development of acute urinary retention in men with BPH/LUTS. Taken together, the available data demonstrate that treatment with inhaled anticholinergic agents is associated with acute urinary retention in men with preexisting LUTS or BPH. Men with LUTS or BPH who are treated with inhaled anticholinergic agents may develop acute urinary retention, but this cannot be quantified based on the limited information available. Inhaled anticholinergic agents should be used when indicated in men with LUTS or BPH, but close monitoring and patient education should be implemented.