Genitourinary Organs Research Articles

Caudal regression syndrome associated with the white matter lesions and chromosome 18p11.2 deletion

Caudal regression syndrome (CRS) is a rare combination of congenital abnormalities characterized by caudal vertebral agenesis/dysgenesis that is usually associated with congenital anomalies of spinal cord, gastrointestinal and genitourinary organs. Although the exact teratogenic mechanism is not known, same environmental, e.g., hyperglycemia and genetic factors appears to play a crucial role in this fetopathy. Herein, we report an unusual case of CRS associated with unspecific white matter lesions and 18p-syndrome manifested by congenital ptosis, hypothyroidism, facial dysmorphy and chromosome 18p11.2 deletion.

Malignant peripheral nerve sheath tumor of the kidney

Malignant peripheral nerve sheath tumors are rare in the genitourinary organs, with few reports of occurrence in the kidney. We describe a patient with a renal malignant peripheral nerve sheath tumor, discovered after excision of a malignant peripheral nerve sheath scalp lesion, with additional masses in the lung and shoulder on metastatic evaluation. This patient underwent neoadjuvant intravenous doxorubicin therapy, followed by surgical resection of the scalp, lung and shoulder lesions in addition to a radical nephrectomy.

Reconstruction of Urinary Tract Combined with Surgical Management of Locally Advanced Non-Urological Cancer Involving the Genitourinary Organs

Introduction: The objective of this study was to review our experience with urinary reconstruction in patients undergoing surgical management for locally advanced pelvic cancer, and to evaluate the role of urologists in these procedures. Materials and Methods: This study included a total of 37 patients undergoing some type of urinary reconstruction due to invasion of the urological organs by locally advanced pelvic cancers, including 17 rectal cancers, 9 cervical cancers, 4 sigmoid cancers, 4 retroperitoneal sarcomas, 2 ovarian cancers and 1 appendiceal cancer. Among these 37, 18 were recurrent cancers following initial surgery for primary tumors. The clinical outcomes of these approaches were retrospectively analyzed. Results: Of the 37 patients, 9 underwent cystectomy (group A) with the following urinary diversions: ileal neobladder in 3, ileal conduit in 5 and colon conduit in 1, and 12 underwent partial cystectomy (group B), among whom 11 received additional urinary reconstruction as follows: bladder flap repair in 5, psoas hitch in 2, ileal ureter in 2, bladder augmentation in 1 and ureteroureterostomy in 1, while the remaining 16 (group C), in whom complete bladder preservation was possible, underwent the following types of urinary reconstruction: bladder flap repair in 6, psoas hitch in 3, en bloc removal of the rectum with prostate in 3, ileal ureter in 2, and ureteroureterostomy in 2. There were 10 early urological complications, including leakage of urine in 7 and acute pyelonephritis in 3. As a late urological complication, hydronephrosis was observed in 8 patients, but ureteral stent was not required in any of these 8. There were no significant differences in the incidence of postoperative complications, the status of surgical margin and the survival among groups A–C. Conclusion: Our experience with extended surgical management of non-urological pelvic cancer with reconstruction of the urinary tract suggests that the urological portion of this procedure can be performed with acceptable morbidity, and that the role of the urological surgeon during this procedure is potentially important.

The modulation of WTI transcription function by cofactors

Wilms' tumour is a paediatric malignancy of the kidneys that affects one in every 10,000 live births, making it the most common solid tumour in the young. This cancer arises due to a failure of the metanephric mesenchyme to differentiate and form the kidney filtration units and tubules, which instead undergo uncontrolled proliferation. WT1 (Wilms' tumour 1) was identified as a factor that is frequently mutated in Wilms' tumours. WT1 plays a central role in the development of the genito-urinary organs and also other regions of the embryo. A major function of WT1 is to act as a regulator of transcription, controlling the expression of genes that are involved in proliferation and differentiation. WT1 can either activate or repress transcription of its target genes. Thus the transcription function of WT1 is highly context-specific, and can be modulated by a number of cofactors. Here, the known interaction partners of WT1 and the mechanisms by which they modulate WT1 transcription function will be discussed.

Renogluteal fistula: An unusual complication of genito-urinary tuberculosis

Involvement of the genitourinary organs is the most common site of extra-pulmonary tuberculosis. Genitourinary tuberculosis (GUTB) almost always starts from the kidney. A wide spectrum of complications can arise from the kidney being affected by GUTB. A rare complication of GUTB in the form of renogluteal fistula is described. Excision of the fistula with nephroureterectomy combined with anti-tubercular treatment has resulted in cure.

A congenital abnormality of the female genito-urinary organs

A congenital abnormality of the female genito-urinary organs

Surgical pathology of the genito-urinary organs. By Arthur E. Hertzler, M.D., Professor of Surgery, University of Kansas. Hertzler's Monographs on Surgical Pathology. Royal 8vo. Pp. 286 + xviii, with 222 illustrations. 1931. London: J. B. Lippincott Co. 21s. net

Surgical pathology of the genito-urinary organs. By Arthur E. Hertzler, M.D., Professor of Surgery, University of Kansas. Hertzler's Monographs on Surgical Pathology. Royal 8vo. Pp. 286 + xviii, with 222 illustrations. 1931. London: J. B. Lippincott Co. 21s. net Surgical pathology of the genito-urinary organs. By Arthur E Hertzler, M.D., Professor of Surgery, University of Kansas. Hertzler's Monographs on Surgical Pathology. Royal 8vo. Pp. 286 + xviii, with 222 illustrations. 1931. London: J. B. Lippincott Co. 21s. net British Journal of Surgery, Volume 19, Issue 76, April 1932, Page 666, https://doi.org/10.1002/bjs.1800197624 Published: 06 December 2005

Urology in War. Wounds and Other Emergencies of the Genito-urinary Organs, Surgical and Medical. By Charles Y. Bidgood, Lt.-Comdr. (M.C.) U.S.N.R., Chief Urologist, U.S. Naval Hospital, Washington, D.C. 9 × 6 in. Pp. 78 + ix, with 27 illustrations. 1942. Baltimore: The Williams & Wilkins Co. (London: Baillière, Tindall & Cox.). 11s. net

Journal Article Urology in War. Wounds and Other Emergencies of the Genito-urinary Organs, Surgical and Medical. By Charles Y. Bidgood, Lt.-Comdr. (M.C.) U.S.N.R., Chief Urologist, U.S. Naval Hospital, Washington, D.C. 9 × 6 in. Pp. 78 + ix, with 27 illustrations. 1942. Baltimore: The Williams & Wilkins Co. (London: Baillière, Tindall & Cox.). 11s. net Get access Urology in War. Wounds and Other Emergencies of the Genito-urinary Organs, Surgical and Medical. By Charles Y Bidgood, Lt.-Comdr. (M.C.) U.S.N.R., Chief Urologist, U.S. Naval Hospital, Washington, D.C. 9 × 6 in. Pp. 78 + ix, with 27 illustrations. 1942. Baltimore: The Williams & Wilkins Co. (London: Baillière, Tindall & Cox.). 11s. net British Journal of Surgery, Volume 31, Issue 121, July 1943, Page 100, https://doi.org/10.1002/bjs.18003112123 Published: 06 December 2005

Surgical diseases and injuries of the genito-urinary organs. By Sir John Thomson-Walker, D.L., M.B., C.M.Ed., F.R.C.S.Eng., Consulting Urologist and Emeritus Lecturer in Urology, King's College Hospital, etc. Second edition, revised: Edited by Kenneth Walker, M.A., M.B., B.C. (Cantab.), F.R.C.S…︁Eng., Jacksonian Prizeman and Hunterian Professor, R.C.S., 1911, 1922, 1924, 1933; Lecturer in Venereal Diseases, St. Bartholomew's Hospital; etc. Medium 8vo. Pp.

Surgical diseases and injuries of the genito-urinary organs. By Sir John Thomson-Walker, D.L., M.B., C.M.Ed., F.R.C.S.Eng., Consulting Urologist and Emeritus Lecturer in Urology, King's College Hospital, etc. Second edition, revised: Edited by Kenneth Walker, M.A., M.B., B.C. (Cantab.), F.R.C.S…︁Eng., Jacksonian Prizeman and Hunterian Professor, R.C.S., 1911, 1922, 1924, 1933; Lecturer in Venereal Diseases, St. Bartholomew's Hospital; etc. Medium 8vo. Pp.

Malignant fibrous histiocytoma of the spermatic cord: A case report

4804 Background: Malignant fibrous histiocytoma (MFH) is a common sarcoma of the soft tissue but it rarely occurs in the spermatic cord. Methods: We present a case of 54-year-old male who presented with a right painless scrotal mass for 1 year, which had progressively enlarged. Past medical history was not significant. Results: Ultrasound and a CT scan of the abdomen and pelvis showed a 7.4x7.1cm solid scrotal mass that appeared to involve the inguinal canal, possibly the spermatic cord on the right side. Metastatic work up was negative. He underwent right radical orchiectomy. Grossly, he was found to have an enormous right hemiscrotal mass, about the size of softball. The left testicle was pushed over from midline, but felt normal. The histologic diagnosis was myxoid malignant fibrous histiocytoma, high grade, focally involving the inked margin. Patient received adjuvent radiation therapy and so far there was no evidence of local recurrence. Conclusions: Malignant fibrous histiocytoma (MFH) is a common sarcoma of the soft tissue in late adult life and is usually found in the region of the extremities and retroperitoneum. It rarely occurs in the genitourinary organs and even rarely in the spermatic cord and so rarely been reported. The pre-operative clinical diagnosis of spermatic cord tumor is difficult and is usually confused with inguinal hernia, spermatocele, epididymo-orchitis and testicular tumor. The definitive diagnosis requires pathologic examination of the surgically resected specimen. It is known to spread rapidly and aggressively with a 2-year survival rates between 34 and 43%. The follow up in the reported cases have been relatively short and the characteristics of this tumor remain poorly understood. No significant financial relationships to disclose.

A ROLE FOR MUSCARINIC RECEPTORS OR RHO-KINASE IN HYPERTENSION ASSOCIATED RAT BLADDER DYSFUNCTION?

Essential arterial hypertension is a frequent condition. Spontaneously hypertensive rats (SHRs) show bladder dysfunction similar to that seen in patients with overactive bladder. Since muscarinic receptors and rho-kinase have a key role in the regulation of bladder contractility, we determined whether alterations of either one might contribute to hypertension associated bladder dysfunction. The bladders of SHRs and normotensive Wistar Kyoto rats (WKYs) were compared in in vitro radioligand binding and contractility studies. The mean total number of muscarinic receptors +/- SEM (181 +/- 14 vs 191 +/- 22 fmol/mg protein) and the relative roles of their subtypes were similar in SHRs and WKYs. Contractile responses to the muscarinic agonist carbachol (maximum effect 2.04 +/- 0.24 vs 2.05 +/- 0.14 mN/mm strip length and -log EC50 5.61 +/- 0.07 vs 5.64 +/- 0.04) and to KCl in a receptor independent manner were similar in the 2 strains. The M3 selective antagonist darifenacin inhibited carbachol responses much more potently than the M2 selective antagonist methoctramine but the potency of the 2 drugs was similar in each strain. The rho-kinase inhibitor Y27,632 attenuated carbachol induced contraction in a quantitatively similar manner in SHRs and WKYs. An altered function of muscarinic receptor subtypes or rho-kinase does not appear to contribute to bladder dysfunction in SHRs.

Assessment of frequency, transmission, and genitourinary complications of enterobiasis (pinworms)

Pinworms are the most common helminth infection in the USA and Western Europe, with prevalence rates in some communities of as high as 30-50%. Pinworms generally live in the gastrointestinal tract, and helminth infestations have been noted in over one-quarter of acute appendectomies on histologic examination. Although transmission is often attributed to the ingestion of infective eggs by nail biting and inadequate hand washing, inhalation and ingestion of airborne eggs also occur. The female Enterobius vermicularis migrates nightly to the perianal area to deposit her eggs, but some worms find their way into adjacent orifices, most commonly the female genitourinary tract, producing an array of symptoms. More consideration of this entity is justified in patients presenting with genitourinary complaints not responding to normal therapies. In the treatment of pinworms affecting genitourinary organs, treatment with possibly two oral agents, namely mebendazole and ivermectin, and a topical therapy for the eggs may be warranted.

Non-coronary heart disease mortality and risk of fatal cancer in patients with treated heterozygous familial hypercholesterolaemia: a prospective registry study

Background: The prognosis from coronary heart disease (CHD) for patients with heterozygous familial hypercholesterolaemia has improved substantially since the introduction of HMG Co-A reductase inhibitors (statins), but the effect of lipid-lowering drug therapy combined with dietary and life style advice on non-coronary mortality and the risk of fatal cancer is unclear. Methods: The cohort of 2871 patients was recruited from 21 outpatient lipid clinics in the UK from 1980 to 1998 and was followed for 22,992 person-years. The standardised mortality ratio (SMR) was calculated from the ratio of the number of deaths observed to the number expected in the general population of England and Wales. Results: There were 169 deaths, including 102 (60.4%) from CHD, and 32 (18.9%) from cancer. The SMR for CHD was 2.5-fold higher than in the general population (95% CI 2.1, 3.1), but the all-cause SMR was not increased (1.1, 95% CI 0.9, 1.3) and non-coronary mortality was significantly lower in men (0.5, 95% CI 0.3, 0.7) and women (0.6, 95% CI 0.4, 0.9). The SMR for all cancers was significantly reduced (0.6, 95% CI 0.4, 0.8) with an 80% reduction in fatal cancers of the respiratory and intra-thoracic organs and a non-significant reduction in fatal cancers of the genitourinary and digestive organs. Conclusions: Although the study cannot exclude the possibility that statins have anti-cancer activity, the results strongly suggest that giving advice to consume a healthy diet, increase physical activity and stop smoking is associated with a substantial reduction in mortality from cancer.

UROLOGICAL INJURIES IN THE CIVIL WAR

This study compiles all cases of urological injuries reported in the Civil War (1861 to 1865). Using original sources largely assembled in army surgeon reports urological injuries documented and treated during the Civil War were recorded as to frequency, type, site and outcome. A total of 1,497 cases of injury involving the genitourinary organs were documented, representing 0.61% of all battle wounds, 22% of gunshot wounds of the abdomen and pelvis, and 47% of wounds restricted to the pelvis. Of these men 342 died (22% of all urological injuries and 37% of fatal pelvic wounds). Half of the kidney, bladder and prostate injuries were fatal, whereas men with injuries of the urethra, testes and penis generally recovered. Urethral wounds were often complicated by traumatic fistula and stricture. Wounds involving genitourinary organs and their consequences had a significant impact during the Civil War. As the war progressed, despite the limited means at their disposal surgeons learned how to better treat devastating urological injuries, resulting in improved survival and fewer severe complications.

Neoplasms in the Navy, 1998–2000: A Descriptive Analysis of the Physical Evaluation Board Database

Records with diagnoses for neoplasms (International Classification of Diseases, Ninth Revision, Clinical Modification, codes 140-239) contained in the U.S. Navy Physical Evaluation Board database for 1998 to 2000 were identified (n = 427 cases, 342 malignant and 85 benign). The four most common sites of occurrence were other and unspecified sites (27%), lymphatic and hematopoietic tissues (22%), benign neoplasms (20%), and genitourinary organs (12%). Crude overall cancer rates were 37.7 cases per 100,000 male subjects and 55.4 cases per 100,000 female subjects. Overall, Hodgkin's disease was the most common diagnosis, with a rate of 3.3 cases per 100,000 population. It also had the highest rate among male subjects, with 3.5 cases per 100,000 male subjects of all ages and 4.2 cases per 100,000 men more than 40 years of age. For women, breast cancer had the highest rate of 8.5 cases per 100,000 subjects. These values are consistent with or lower than the published reports of U.S. Navy and national rates. Ongoing surveillance of malignancies among Navy personnel is an important part of force health protection.

COOL (TRPM8) AND HOT (TRPV1) RECEPTORS IN THE BLADDER AND MALE GENITAL TRACT

Overactive bladder symptoms due to various etiologies have been successfully treated with capsaicin by desensitization of the temperature sensitive vanilloid receptor TRPV1. Recently another temperature sensitive receptor, TRPM8, activated by menthol and cool temperatures (8C to 28C) was described that may be the proposed cool receptor, at least in part mediating the bladder response in the diagnostic ice water test. We defined the sites of mRNA and protein expression of TRPM8 and TRPV1 in the rat and human genitourinary tract. Prostate, testis, penis, bladder and dorsal root ganglion tissue was obtained from rats. Prostate, testicle, seminiferous tubules, corpus cavernosum, glans, overlying glans skin, scrotal skin and bladder were obtained from human patients. Reverse transcription-polymerase chain reaction was done using species specific primers for TRPM8 and TRPV1. Immunofluorescence staining for TRPM8 was performed in rat tissues as well as in cultured human urothelial cells. TRPM8 and TRPV1 mRNA were detected in all rat tissues. Human samples demonstrated TRPM8 mRNA in prostate, testicle, seminiferous tubules, scrotal skin and bladder. No TRPM8 mRNA was identified in human corpus cavernosum, glans or overlying glans skin. Separation of layers in human bladder demonstrated mRNA for TRPM8 only in the urothelium and not in the detrusor. Immunofluorescence location of TRPM8 was found in rat prostate, DRG and bladder, and in human urothelial cells in culture. TRPV1 mRNA was detected in all human genitourinary tract tissues. These results demonstrate that mRNA and protein for TRPM8 exist in multiple genitourinary organs in the rat and human, and it may be considered a possible new target, as is TRPV1, for the pharmacological treatment of detrusor overactivity or other urological disorders.

後腹膜しょう液性嚢腫の１例

症例は59歳,女性.平成13年11月,下痢を主訴に近医を受診したところ,右側腹部腫瘤を指摘され当院に紹介された.当院受診時,右側腹部に弾性軟,小児頭大の腫瘤を触知した.腹部CTでは右後腹膜腔に12×7 cmのlow density massとして描出され,注腸造影検査において,上行結腸は著名に左側に圧排されていた.後腹膜漿液性嚢胞の診断のもと,腫瘍摘出術を施行した.腫瘤は非常に薄い嚢胞壁を有し,その内容物は無色透明の液体であった.内溶液のCA19-9, CEA値はそれぞれ10,000U/ml以上, 344.5ng/mlと高値を示したが,細胞診は陰性であり,嚢胞壁にも悪性所見は認めなかった.後腹膜嚢腫は稀な疾患であり,若干の文献的考察を加え報告する.

Kidney and Testicle Injuries in Team and Individual Sports: Data From the National Pediatric Trauma Registry

We define the risk of kidney or testicle injury in children who play contact sports. National Pediatric Trauma Registry data from 50 United States pediatric trauma centers for 1990 to 1999 were analyzed. The data were from age groups 5 to 11, 12 to 14 and 15 to 18 years. Major abdominal injuries, injuries due to team and individual contact sports, and the site of injury were examined. Of the 81,923 cases 5,439 were sports related. Abdominal injuries occurred in 459 patients (0.56%), and were due to contact sports in 191. Team sports were involved in 184 cases, including football in 44%, hockey in 19%, baseball in 15%, soccer in 12% and basketball in 6%. Abdominal injury rate by age was 16% for 5 to 11-year olds, 42% for 12 to 14-year-olds and 42% for 15 to 18-year-olds. Most common was splenic injury at 50% of cases, kidney injuries occurred in 22% and no testicle injuries were reported. Football accounted for the most kidney injuries (62%). Kidney injuries were more common among older teenagers. No injuries led to nephrectomy. Abdominal injuries are rare in children who play team and individual contact sports. No testicular injuries were reported. Kidneys are most at risk in football. Splenic injuries are most common overall, although the risk to kidney and spleen is equal in basketball. No kidneys were reported as lost. These data should help families and schools when assessing risk to genitourinary organs during these activities.

Patología inflamatoria en urología. sistematización

The recognition, identification and management of the many events taking place in relation to an inflammatory response has become a rapidly growing field in medicine over the last few years. In this sense, the progress made in later years in the study of the molecular and cellular mechanisms of tissue inflammatory reactions in sites such as synovial membranes, gut mucosa, vascular endothelium etc, is considered highly relevant.A number of authors conscious of such events work on the standardization of clinical models of the inflammatory responses of genitourinary organs resulting from the action of a variety of harmful events. This review is warranted by the prevalence and morbidity and mortality of inflammatory conditions, as well as the complex work of incorporating to Urology the findings from other Biomedical Sciences.

Pelvic exenteration for advanced colorectal cancer with reconstruction of urinary and sphincter functions.

Total pelvic exenteration (TPE) for the treatment of advanced colorectal cancer usually involves a double stoma for faecal and urinary excretion, which reduces patient quality of life. In this study, a stomaless reconstruction method for patients normally requiring TPE was evaluated. Five patients underwent stomaless TPE. After removal of the tumour with an adequate surgical margin, the urethra was transected at the urogenital diaphragm and the rectum at the anal canal. An ileal neobladder was constructed and coloanal anastomosis was performed. The major omentum was used to construct a septum between the anastomoses. A transgastric ileus tube was used as an intestinal stent to prevent ileus. All patients were alive 12-39 months after operation. Faecal continence was preserved in four patients whose diverting colostomies were closed. All five patients were able to void urine spontaneously, with daytime continence. All but one, in whom cancer recurred, were mobile in the community. Stomaless TPE may be considered for locally advanced colorectal cancers that invade the genitourinary organs, provided that neither the anal canal nor the urogenital diaphragm is affected.