Distended Urinary Bladder Research Articles

Ultrasound evaluation of scar thickness for prediction of uterine dehiscence in term women with previous caesarean sections.

To determine the role of ultrasound in evaluation of scar thickness for prediction of uterine dehiscence. This retrospective cross-sectional study was conducted in the Radiology department of Aga Khan University Hospital from 1st July to 31st December 2021 after approval from the University Ethic Committee. In this study pregnant women 18 to 40 years with a live singleton fetus with vertex presentation, at term, with history of prior caesarean section and availability of medical record were included. Using a curvilinear ultrasound transducer with optimally distended urinary bladder, the myometrial thickness was measured in the sagittal plane. The intraoperative visual findings of the lower uterine segment outcome at the time of C-section were recorded and categorized into two groups i.e., with and without dehiscence for statistical analysis. A total of 126 women were included. The mean age of the study participants was 29.8±4.1. The median gestational age was 35 (34-37) weeks. The highest AUC 0.58 was recorded for the scar thickness of ≤2.5mm with a sensitivity, specificity, PPV and NPV of 80.9%, 36.4%, 36.3% and 80.8% respectively. Similarly, the AUC for the scar thickness of ≤2mm was 0.55 with a sensitivity, specificity, PPV and NPV of 93%, 18.2%, 18.2% and 93% respectively. Transabdominal Sonography is a safe technique to determine the LUS thickness during antenatal ultrasound at term. A cutoff value of ≤2mm showed a high sensitivity and negative predictive value of 93% for evaluating the risk of uterine dehiscence.

Modified tube cystostomy technique for management of obstructive urolithiasis in small ruminants: procedure and outcome in 17 sheep and goats.

To describe the surgical technique and clinical outcome of small ruminants treated for obstructive urolithiasis using a modified tube cystostomy (MTC) technique. 15 goats and 2 sheep treated with an MTC between March 2018 and February 2023. Animals were diagnosed with obstructive urolithiasis on the basis of history, physical examination, and ultrasonographic examination. An MTC was performed with sedation and a local block. Postoperative medical management was instituted to help reestablish urethral patency, and Foley catheters were removed after successful urination. Animals were hospitalized an average of 3 nights (range, 0 to 14 nights). Complications included urine spillage in the abdomen and accidental deflation of the Foley balloon. Six animals were euthanized due to poor prognosis or failure to regain urethral patency. Foley catheters were removed an average of 15.7 days postoperatively in animals that regained urethral patency. Long-term (> 1-month) follow-up was available for 8 animals, with an average postoperative survival time of 19.4 months (range, 1 to 58 months). Four animals were lost to long-term follow-up. This MTC technique is an effective means of catheterizing the urinary bladder in small ruminants. It can be performed under field conditions and serve as a standalone procedure for providing temporary urine egress. Patient size is limited by the length of the introducer, and an intact, distended urinary bladder and plan for reestablishing urethral patency are important considerations.

Discolored urine in sheep and goats: Clinical, etiological, hematobiochemical, sonographic and postmortem findings.

Bloody urine is classified in farm animals as hematuria, hemoglobinuria, and myoglobinuria. In small ruminants, discolored urine is reported due to several etiologies which is sometimes fatal. Of these causes are babesiosis, bacillary hemoglobinuria, copper toxicity, and hypophosphatemia. This study was designed to investigate the clinical, etiological, hematobiochemical, ultrasonographic, and pathological findings in rams and bucks with red urine syndrome. Eighteen male animals (nine rams and nine bucks) of 6 months to 3 years were examined. Parallel, 10 healthy controls were used. They were admitted due to red urine, voiding of only urine drops, straining during the act of urination, grunting during urination, ventral abdominal edema, and abdominal distension. The duration of the disease ranged from 2 to 30 days. A history of chronic copper toxicosis was informed in two bucks and a ram. Two blood samples were collected from diseased as well as from controls in EDTA tubes (for complete blood count testing) and in plain tubes (for serum collection). Hematuria was found in 11 animals (seven bucks and four rams) while hemoglobinuria was detected in seven animals (five bucks and two rams). Sonographic findings in diseased animals included ruptured urinary bladder in 3, ruptured urethra in 5, penile calculi, uroperitoneum in 6, distended urinary bladder in 7, hydronephrosis in 5, echogenic deposits in the bladder in 3, and ventral urine accumulation in four animals. Laboratory evaluation of a Geimsa-stained blood smear confirmed the infection with Babesia in three bucks and a ram. Hemolytic anemia was marked in two bucks and a ram due to chronic copper toxicity. Biochemical abnormalities included hypoalbuminemia, hyperglobulinemia, increased blood urea nitrogen and creatinine concentration, and hyperglycemia. Postmortem examination was carried out on six animals (four rams and two bucks). Discolored urine in rams and bucks in this study resulted from hematuria due to urinary calculi and pelvic abscessation or from hemoglobinuria due to Babesia infection or due to copper toxicity. Hemolytic anemia was the outstanding hematological finding and hypoalbuminemia, hyperglobulinemia, increased blood urea nitrogen (BUN) and creatinine, and hyperglycemia were the characteristic biochemical findings. Sonography of the urinary tract was very helpful in assessing the renal parenchyma, urinary bladder, and abdominal cavity for the verification of urolithiasis, hydronephrosis, intact or ruptured urinary bladder, uroperitoneum, and perforated urethra.

A rare congenital anomaly in a female child with acute urinary retention—female hypospadias: a case report

BackgroundFemale hypospadias is a rare congenital anomaly and defined as a female urethral opening on the anterior vaginal wall. Diagnosis is challenging due to its rarity. Different anatomical variations exist depending on the location of the urethral opening. Clinical presentation can vary from asymptomatic until end-stage renal disease due to lower urinary tract obstruction. This case highlights the important clinical and radiological features of female hypospadias. Surgical treatment remains the mainstay management for this entity.Case presentationWe report a case of a 5-year-old girl presented with 3 days of lower abdominal pain, vomiting and difficulty in voiding. She was previously well. Abdominal examination revealed a palpable suprapubic mass arising from the pelvis up to the umbilicus. Perineal examination showed a single opening at the introitus. Ultrasound showed a grossly distended urinary bladder and bilateral mild hydroureteronephrosis. Catheterization of the opening failed to decompress the bladder, and a suprapubic catheter was inserted which drained 500 cc of clear urine. She also developed acute kidney injury which resolved after suprapubic drainage. Cystogram and genitogram failed to delineate the communication between the urinary bladder and vagina. However, cystovaginoscopy revealed a normal vagina opening, and the urethral meatus entered the anterior wall of the vagina distally. She underwent a meatoplasty and recovered well after surgery.ConclusionAttention to important clinical and radiological features helps in the diagnosis of female hypospadias. Female hypospadias should be suspected in female patient with single opening at the introitus, acute urinary retention and failed urinary catheterization. Cystovaginoscopic examination is required to diagnose this condition. Urethroplasty is curative with good outcome for low type of female hypospadias.

Correlation of ureteric jet angle (UJA) with vesicoureteral reflux grade and its assessment as a noninvasive diagnostic parameter to detect vesicoureteral reflux

BackgroundVesicoureteral reflux (VUR) is an essential urogenital entity affecting infants and younger children. Many patients present late with recurrent urinary tract infections (UTIs), which lead to chronic pyelonephritis, renal scarring, and end-stage renal disease (ESRD). This progression in disease adds to significant morbidity and mortality in the paediatric age group. Voiding cystourethrography (VCUG) is the investigation of choice which is an invasive procedure and is related to the risk of ionizing radiation and iodinated contrast administration. Ureteric jet angle (UJA) is a Doppler parameter that can be obtained by measuring the angle between the horizontal axis of the floor of the optimally distended bladder and the Doppler ureteric jet at the ureteral opening into the bladder. The study aimed (1) to investigate the correlation of UJA with VUR grade and (2) to assess the utility of UJA as a noninvasive diagnostic indicator to diagnose VUR as an alternative to VCUG.MethodAll paediatric patients with urinary complaints were evaluated by voiding cystourethrography (VCUG) for assessment of grades of VUR, followed by colour Doppler evaluation of ureteric jets. VCUG interpretations were made.UJA was calculated as the angle between the long axis of the colour Doppler jet and the horizontal axis of the floor of the optimally distended urinary bladder on colour Doppler examination. Ureteric jet angles were recorded on both sides irrespective of the presence of VUR, and data were analysed using SPSS. The correlation coefficient (r) with p value was calculated. The diagnostic efficacy of UJA (58° or more) to detect VUR was assessed by calculating sensitivity, specificity, PPV, NPV, positive LR and negative LR. The AUC was calculated to evaluate the diagnostic efficacy of UJA 58° or more to detect VUR.ResultsIn total, 34 (68 renal units) children (8 months–12 years), including 20 males (M) and 14 females (F), examined. The mean age was 4.96 ± 2.87 years for the total population, including 4.60 ± 2.02 years for boys and 5.47 ± 2.75 years for girls. Twenty-one patients (10 girls and 11 boys) showed VUR on MCUG. Eight patients showed high grades (grade III–V), including seven boys and a girl. The range of UJA in VUR-negative patients was 27–60° with a median angle of 42.03°. VUR-positive patients showed an angle range of 32–71°with a median angle of 62.13°. High-grade VUR was seen in 8 patients with an angle range of 59–84° and a median angle of 76.31°. A positive correlation (r = 0.81) was noted between UJA and VUR grading. The sensitivity and specificity of angle > 58° to detect VUR were 0.66 and 0.92 with PPV 0.93 and NPV 0.63. Yuden’s J value was 58°. The value for the area under the curve was 0.7.ConclusionsPositive linear correlation was seen between UJA and VUR grades with high specificity and positive predictive value. The Diagnostic Utility of UJA 58° as a screening method to detect severe VUR was acceptable and can be further studied with a larger sample size.

Perineal urethrostomy in a ferret (Mustela putorius furo) to treat iatrogenic urethral stricture after orchiectomy

AbstractA 5‐month‐old ferret (Mustela putorius furo) was presented with a recent history of stranguria, distended urinary bladder, post‐renal azotaemia and a severed urethra following orchiectomy at the referring practice 4 weeks previously. At presentation, an indwelling urinary catheter was present, and the general examination was unremarkable. Blood analyses showed increased serum urea levels. An abdominal ultrasound showed no abnormalities. Contrast cystourethrography revealed a urethral stricture at the level of the castration site. Perineal urethrostomy was performed proximal to the stenosis, caudal to the pubis bone. Examination of the stoma 3 weeks postoperatively showed good healing and no stenosis. No recurrence of signs was reported at regular follow‐up phone communication with the owner up to 11 months postoperatively. Urethral stricture is a possible complication following orchiectomy in ferrets, and a perineal urethrostomy can be performed.

Adnexal cyst masquerading as a distended urinary bladder

A 45 year old female with Diabetes presented with bloating, abdominal distension and urinary urgency for past 3 months. On examination, there was suprapubic tenderness with a large palpable mass in the location of the urinary bladder that was seen extending to the umbilicus

(071) Vulvo-vaginal Obliteration: Presentation of 6 Cases

Abstract Introduction Between December 2018 and July 2022, six cases of vulvovaginal fusion (obliteration) were diagnosed, evaluated, and treated at our centers. Less than 30 cases have been reported according to our reviews of the medical literature. All of the cases presented shared certain features such as more than 2 decades without sex or masturbation, no use of hormone replacement therapy, and a history of chronic urinary tract infections. Objective 1. Present information from 6 cases of a rare genitourinary disorder, its diagnosis, medical & surgical management, follow-up, and resolution. 2. Place vulvovaginal obliteration or labial fusion as one of the most extreme late consequences of untreated genitourinary syndrome of menopause. 3. Emphasize not only the importance of the use of local estrogen in all women going through menopause but also clarify and promote the importance of the maintenance of penetrative sexual activity in the lives of older women. This can be achieved either naturally or with the use of dilators and sexual toys. Methods We analyzed 6 cases of patients with vulvo-vaginal obliteration that presented in our facilities. Results Analysis of the 6 cases showed: In 3 out of the 6 cases, the patient didn’t have a partner, while in the other 3 cases, they were not sexually active with their partner in any way. In 2 of the cases, the patient’s main complaint was the inability to urinate due to obstruction of the urethral outlet by a fused labia. In both cases, urinary leakage from overflow was present in the area of the posterior fourchette, along with urocolpos, an extremely distended urinary bladder, bilateral megaureter, and hydronephrosis. The ages of these 6 women were between 72 to 94. The most severe case involved a patient with the longest time without penetration (> 30 years). Conclusions Total and partial vulvovaginal obliteration is a disease that hasn’t been commonly described. By obtaining the sexual history of each patient and the practice of geriatric gynecology, we have been able to diagnose this disorder. There is no doubt that vulvovaginal obliteration, also known as labial fusion, is one of the most extreme complications of the genitourinary syndrome of menopause but has not been medically described as part of its findings up till now. The prevention and treatment include not only the local use of estrogen but also the education of the patients on the need to maintain penetrative sexual activity in order to prevent the atrophy of the genitourinary area and maintain its functional ability. This can be done with a partner, penetrative dilators, or sexual toys. Disclosure No

(460) A Case Series on Vulvovaginal Obliteration

Abstract Introduction Between Dec. 2018 & June 2020, 5 cases of Vulvovaginal Obliteration, also known as Labial Adhesion were diagnosed, evaluated and treated. All of the presenting cases had a history which shared certain features, including more than 2 decades without sexual activity, no history of masturbation, no use of hormone replacement therapy and chronic urinary tract symptoms. The most severe case had the longest period without vaginal penetration (>30years). In 3 of the 5 cases the patients didn't have a partner, while the other 2 patients were not sexually active with their partner in any way. Objective To add new cases to the literature about this rarely described disorder. To show this condition is one of the most extreme consequences of Genitourinary Syndrome of Menopause. To demonstrate the importance of vaginal penetration and hormone replacement therapy (HRT) to prevent postmenopausal labial adhesion. Methods This is a case series reviewing the effective management of labial adhesion in post-menopausal women. Results In 2 of the cases the patients main complaint was their inability to urinate due to obstruction of the urethral outlet by the fused labia. This obstruction caused urocolpos, extremely distended urinary bladder, megaloureters, & bilateral hydronephrosis. Leakage of urine also occurred at the posterior fourchette. All of these urinary symptoms disappeared after an urgent introital incision was performed in the OR. In both cases the exclusive use of local estrogens postoperatively failed to prevent recurrent closure. Only the combined use of local estrogens and the regular use of dilators (3-4 times/day/2 weeks, then 1-2 times /day/2 weeks, then PRN) prevented recurrence. In 3 of the 5 cases, regular use of the dilators caused them to reach orgasm for the first time in their lives. The ages of these women were between 76 & 92 years old. The last 2, and more mild cases had 50% labial fusion, without urinary retention. The use of progressively increasing sizes of dilators and estrogen cream resolved the problem without surgical interventions. Conclusions Labial adhesion is one of the worst consequences of GSM, due to progression towards urinary retention. It is caused by insufficient maintenance of sexual activity after menopause, combined with lack of prevention with HRT, and is successfully managed with surgery, dilators and topical estrogens. Disclosure No

Encephalitozoon cuniculi Infection of Domestic Rabbits (Oryctolagus cuniculus) in Slovenia between 2017 and 2021.

Encephalitozoon cuniculi is a microsporidial parasite that primarily infects domestic rabbits (Oryctolagus cuniculus). It is the causative agent of encephalitozoonosis, a disease with an internationally recognized seroprevalence among rabbits. This study determines the presence, clinical manifestation, and serological status of encephalitozoonosis in pet rabbits in Slovenia using various diagnostic procedures. From 2017 to 2021, 224 pet rabbit sera were collected and tested for encephalitozoonosis with the indirect immunofluorescence assay. Immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies against E. cuniculi were confirmed in 160 (65.6%) cases. Most seropositive rabbits suffered from neurological clinical signs or signs of gastrointestinal disorders such as recurrent hypomotilities, chronic weight loss, cachexia, or anorexia, and fewer showed clinical signs related to the urinary system or phacoclastic uveitis. A quarter of the positively tested rabbits presented without clinical signs. Hematological and biochemical blood analysis confirmed that seropositive animals had elevated globulin and deviated albumin levels in comparison to the normal reference values of non-infected animals. Furthermore, rabbits with neurological clinical signs showed statistically significant higher levels of globulins and total protein. Sixty-eight whole-body radiographs and thirty-two abdominal ultrasound reports were analyzed, looking for changes in the shape or size of the urinary bladder, presence of urinary sludge or uroliths, and any abnormalities related to the kidneys (shape, size, or nephrolites). The results suggest that neurological defects in the urinary bladder caused by E. cuniculi lead to a distended urinary bladder and consequently dysuria, incontinence, urine scalding, and sludgy urine.

Response to comments on 'Hypertension and tachycardia following high spinal anaesthesia during LSCS: An unusual presentation'.

Dear Editor, We read with interest the comments[1] to our published article,[2] and we would like to address the queries raised on a point-to-point basis. With regard to the timeline of events during the episode of hypotension, we would like to reiterate that, as mentioned in the article,[2] the blood pressure (BP) of the patient fell to 78/40 mmHg immediately after the administration of the subarachnoid block, and that following this vasopressors and intravenous (IV) fluids were given. After one minute, her BP had improved. However, after five minutes of our having administered the subarachnoid block, she complained of breathlessness. Closed breathing circuits have myriad advantages, such as providing a constant and higher fraction of inspired oxygen (FiO2), removing carbon dioxide from the expired gases, and offering lesser resistance when compared to an endotracheal tube. The work of breathing may increase when the adjustable pressure-limiting (APL) valve is partially or fully closed, providing an obstacle to the egress of gases, or when the set flow is not enough to meet the patient’s peak inspiratory flows.[3] However, the APL valve was kept open when applying the closed circuit on our patient, and a flow of 15 L/min was ensured, thereby thwarting any possibility of increased work of breathing. Our patient presented with breathlessness stemming from hypoventilation, which was more a cause rather than a symptom of probable hypercarbia. She exhibited mild agitation at that time but did not appear confused or flushed. We were unable to corroborate our clinical findings with a blood gas, as stabilizing the mother and baby took precedence over the former. However, the tidal volume and end-tidal capnography were suggestive of hypoventilation and resultant hypercarbia. We again reiterate that, as mentioned in our article,[2] other possible causes of hypertension, such as distended urinary bladder, patient anxiety, inappropriately sized non-invasive BP cuff, and pre-existing hypertensive disorders, were ruled out. Informed consent The patient has given informed consent. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Correlation of a distended urinary bladder volume with lethal intoxication in general and for different substance subgroups in particular: A retrospective study

Correlation of a distended urinary bladder volume with lethal intoxication in general and for different substance subgroups in particular: A retrospective study

Tribrachius parapagus diencephalus conjoined twin

A conjoined twin of male gender, weighing 3 kgs was born at 36 weeks of gestation to a primigravida mother. The twin cried immediately after birth. The twin had a single trunk, three upper limbs, two lower limbs and two separate heads joined at the trunk , single anal opening and male external genitalia. Antenatal USG at 35 weeks showed polycephaly live intrauterine fetus with breech presentation with anteriorly placed placenta maturity grade II with gross fetal anomaly, polyhydramnios with distended fetal urinary bladder (bladder volume: 63ml). The twin had respiratory distress on admission, so oxygen support was given. Babygram done was suggestive of two separate vertebral columns from cervical to lumbosacral region. 2D echo shows 2 hearts. Twin was managed conservatively, started on NG feeds and discharged in stable condition.

Spontaneous Renal Calyceal Rupture Secondary to Bladder Outlet Obstruction

A 78-year-old female presented with chief complaints of nausea and vomiting for three days associated with generalized weakness and altered mental status. On examination, she was tachycardic and tachypneic with suprapubic distension and generalized tenderness with guarding. Urinalysis revealed urinary tract infection picture. Initial blood work showed leukocytosis, hyperkalemia, lactic acidosis, and acute kidney injury. CT Abdomen without contrast showed marked fluids surrounding the left kidney, bilateral hydronephrosis, and distended urinary bladder. She was treated with intravenous antibiotics and fluids for urosepsis secondary to complicated urinary tract infection with acute kidney injury due to obstructive uropathy. Follow-up renal ultrasound later revealed resolution of left perinephric fluids 3 days after alleviation of obstructive uropathy, thus suggesting a likely diagnosis of spontaneous left renal calyceal rupture.

Correlation of a Distended Urinary Bladder Volume with Lethal Intoxication in General and for Different Substance Subgroups in Particular: A Retrospective Study

Correlation of a Distended Urinary Bladder Volume with Lethal Intoxication in General and for Different Substance Subgroups in Particular: A Retrospective Study

Adverse events in women giving birth in a labor ward: a retrospective record review study

BackgroundChildbirth could negatively affect the woman’s health through adverse events. To prevent adverse events and increase patient safety it is important to detect and learn from them. The aim of the study was to describe adverse events, including the preventability and severity of harm during planned vaginal births, in women giving birth in the labor ward.MethodsThe study had a descriptive design with a retrospective birth record review to assess the preventability of adverse events using the Swedish version of the Global Trigger Tool. The setting was a labor ward in Sweden with low-risk and risk childbirths. Descriptive statistics, Pearson’s Chi-square test and Student’s t-test were used.ResultsA total of 38 adverse events (12.2%) were identified in 311 reviewed birth records. Of these, 28 (73.7%) were assessed as preventable. Third- or fourth-degree lacerations and distended urinary bladder were most prevalent together with anesthesia-related adverse events. The majority of the adverse events were classified into the harm categories of ‘prolonged hospital care’ (63.2%) and ‘temporary harm’ (31.6%). No permanent harm were identified, but over two-thirds of the adverse events were assessed as preventable.ConclusionsThis first study using Global Trigger Tool in a labor ward in Sweden identified a higher incidence of adverse events than previous studies in obstetric care. No permanent patient harm was found, but over two-thirds of the adverse events were assessed as preventable. The results draw particular attention to 3rd-or 4th-degree lacerations, distended urinary bladder and anesthesia-related adverse events. The feedback on identified adverse events should be used for systematic quality improvement and clinical recommendations how to prevent adverse events must be implemented.

A Case of Congenital Urethrovaginal Fistula in a Female Child with Suspected Imperforate Hymen: A Case Report

Urethrovaginal fistula is an abnormal communication between the urethra and vagina. Urethrovaginal fistula results in urinary incontinence with urine continually leaking from the vagina. In children congenital anomaly may also be the cause. Congenital Urethrovaginal fistula is an extremely rare genitourinary anomaly. The reported five cases in the literature are all associated with urogenital abnormalities like vaginal septum, vaginal agenesis and imperforate hymen. We present a case of a 7-year-old female that was referred from a peripheral hospital for micturating cystourethrography (MCUG) on account of urinary incontinence and passage of urine from vaginal orifice. Following MCUG the urethra, proximal fistula between the urethra and vagina, distended urinary bladder, contrast opacified uterus and a fallopian tube were all demonstrated. We report this case because of its rarity in the literature.

Prevalence of Urinary Tract Conditions and Factors Associated with Urolithiasis in Domestic Cats in Nairobi, Kenya

This was a retrospective study that covered a 10-year period from January 2009 to December 2018. The study had three aims which were to determine prevalence, clinical manifestations and factors associated with urolithiasis in domestic cats in Nairobi County, Kenya. It also considered prevalence of other urinary tract conditions that occurred in domestic cats in the same county. Clinical data of all cases of cats were collected from 5 purposively selected veterinary clinics. Specific data was retrieved, which included breed, sex, age, weight, neuter history, and clinical findings. Univariate and multivariate analysis was done to determine factors associated with urolithiasis. The total number of domestic cat cases in the 10-year period was 4,404. A total of 104 cases had urinary tract conditions, of which 28 had urolithiasis, thus making general overall prevalence of urinary tract conditions to be 2.4% and prevalence of urolithiasis 0.6%. Among cases with urinary tract conditions, prevalence of urolithiasis was 26.9%. Definitive diagnosis of causes of urinary tract disease in cats was recorded in 75 cases. Urolithiasis was the major cause 37.3% followed by idiopathic feline lower urinary tract diseases and idiopathic cystitis both at 22.7%. The results showed that history of dysuria, distended urinary bladder and body weight were significantly associated with urolithiasis in domestic cats. This current study concluded that prevalence of urolithiasis in Nairobi County, Kenya was low, but among cases with urinary tract conditions, it had the highest prevalence. These findings were different from similar literature where idiopathic cystitis is reported to be the major cause of urinary tract disease in cats. The main clinical symptoms of cats suffering from urolithiasis were dysuria, hematuria, stranguria, distended urinary bladder and painful abdomen.

Cat Pelvic Fractures

An eight-month-old, 2.7 kg, male, neutered mixed breed cat was presented at the Sokoine University of Agriculture Teaching Animal Hospital with a history of lameness involving hind limbs, lethargy, anorexia and failure to urinate or defecate. Abdominal palpation revealed a distended urinary bladder and firm faeces within the colon. Manipulation of the hips elicited pain and lower lumbar pain was also elicited on palpation. Radiographic examination revealed, an old fracture of the sacrum, lordosis of the lumbar spine with indented vertebral end plates, left sacroiliac joint subluxation and abnormally ventral angling of the ilial wings. Narrowing of the pelvic canal was also observed. A diagnosis of old fractures of the sacrum, left sacral iliac subluxation and narrowing of the pelvic canal was made based on the history, clinical and radiographic examination. Limitation of activity for three weeks was recommended to facilitate healing process. The owner reported the patient had a gradual recovery from lameness. Computed tomography would have provided further insight on the nature and severity of the fractures that the animal sustained. However, it was not done due to unavailability

Frank haematuria secondary to ruptured pseudoaneurysm of the inferior vesical artery: a case report and review of the literature

BackgroundPseudoaneurysm of a vesical artery is an extremely rare iatrogenic complication; however, it may cause fatal haematuria.Case presentationA 21-year-old Arab Jordanian male had multiple optical urethrotomies for an iatrogenic urethral stricture after he had rectal surgery for Hirschsprung’s disease at the age of 2 years. During one of his admissions to the Emergency Room (ER) with urinary retention, an attempt at suprapubic catheter insertion was complicated by massive bleeding at the insertion site of the catheter. Abdominal exploration showed a distended urinary bladder with clots and bleeding seen at the bladder neck that was controlled with multiple sutures. The patient rebled again two times; the first was controlled with cystoscopy and cautery for a pulsatile bleeder seen at the bladder neck. The second time, the patient required blood transfusion of three units of packed red blood cells. Angiography was performed, and a pseudoaneurysm at the base of the urinary bladder from the inferior vesical artery was diagnosed, which was controlled by embolization.ConclusionPulsatile bladder haemorrhage following urological intervention is suggestive of pseudoaneurysm or arteriovesical fistula, and angiography with embolization is recommended.