History Of Dysuria Research Articles

A rare case of anterior vaginal wall leiomyoma.

A 35-year-old female para 3 was presented to the outpatient department with complaints of something coming out per vaginum since 2 months. There was history of dyspareunia but no history of dysuria, increased frequency, or any feature of urinary retention. The patient complained that she noticed something appeared to come down her vagina for the last 2 months. A prevaginal examination revealed a mass in the vagina, which was about 3 cm below urethra (Figs. 1, 2). On per speculum examination, cervix was seen separately from mass (Fig. 3). An ultrasonography was performed which showed normal-sized uterus, and bilateral adnexa was normal. There was no other abnormality on ultrasonography. Her consent was taken for surgery as well as for photography and for publishing of the case. Her cystoscopy was done which was normal. There was no growth from the bladder. Both ureters were seen separately. The tumor was surgically removed by vaginal route (Figs. 4, 5). A Foley’s catheter was introduced in the urethra for protecting the urethra. The tumor was enucleated by blunt dissection, but there was a vascular pedicle which was bleeding profusely. This pedicle needed ligation for profuse bleeding. The pedicle was apparently arising from the muscles of bladder wall (Fig. 5). Hence during the removal of the pedicle, there was accidental injury to bladder. There was a small rent in bladder wall from which dribbling of urine was seen. Further, this was confirmed by instilling methylene blue and saline in bladder retrograde through foley’s catheter. The rent in bladder was sutured in two layers by no 2 vicryl: inner continuous interlocking layer and outer interrupted layer. Bladder injury could have been prevented by more careful dissection of the pedicle. Koranne P. S. (&), Assistant Professor Uike P., HOD Department of OBGY, GMC Akola, Shankar Nagar, Ghatole Layout, Jatharpeth, Akola 444005, Maharashtra, India e-mail: prachi_kornne@yahoo.com

English

Isolated tubercular epididymo-orchitis usually presents with a clinical pictures and radiographic illustrations similar to those of a testicular neoplasm; therefore diagnosis may be challenging for clinicians. In our case, a 25years male presented with bilateral testicular swellings without any evidence of tuberculosis elsewhere in the body. We report this case firstly because isolated epididymo-orchitis is an unusual presentation of tuberculosis. Secondly this case may help clinicians in diagnostic approach when testicular tuberculosis masquerade testicular neoplasm, and thus avoids unnecessary orchiectomy and save the clinicians from the possible charges of medical negligence. CASE REPORT: A 25 years male, non-smoker presented in surgery OPD with complains of swelling of both testes with pain over a period of 6 months; Testicular swelling was gradually increasing in size. There was no history of fever, weight loss, night sweats, cough or haemoptysis. Even there were no history of dysuria, frequency, urgency of micturition or history of any trauma. He has two children. clinical examination of chest and the abdomen were normal. Physical examination of the genitalia revealed firm enlargement of both testes with irregular surface, while epididymis and spermatic cords were thickened. The scrotal skin showed no signs of inflammation. Transillumination test of the swellings was negative. There was bilateral inguinal lymphadenopathy. Prostate was found normal on digital rectal examination.

P-017 YI Spontaneous Closure of Enterovesicular Fistula with Adalimumab

Crohn’s disease is a chronic inflammatory disorder which affects approximately 700,000 patients in the United States. Of these patients, up to 40% will have fistulizing disease, which represent a more aggressive phenotype often failing medical therapy and requiring surgery for definitive treatment. We present 2 cases of fistulizing Crohn’s disease complicated by entero vesicular fistula successfully treated with Adalimumab monotherapy. Case 1: 23 y/o male who presented to Walter Reed National Military Medical Center (WRNMMC) with a 4 month history of RLQ pain, relapsing fevers, pneumaturia and dysuria. Evaluation via CT Scan of the Abdomen was significant for long segment terminal ileitis with evidence of an entero-vesicular fistula. Colonoscopy showed nodular and erythematous terminal ileal mucosa with biopsies confirming Crohn’s ileitis. Cystoscopy revealed an area of erythematous and edematous mucosa along the posterior bladder wall. An initial prolonged course of Ciprofloxacin and Metronidazole partially improved symptoms. The patient was started on Adalimumab induction dosing followed by 40 mg subcutaneously bi-weekly with complete resolution of symptoms over the course of 2 months. Subsequent MRE showed no evidence of fistulous tract along with significant improvement in small bowel disease. The patient remains in clinical remission approximately 1 year after initiation of Adalimumab. Case 2: 27 y/o male who presented to WRNMMC with a 1 month history of dysuria, fecaluria, hematuria and scant hematochezia. Patient was initially evaluated at Landsthul Army Medical center, Germany where he underwent cystoscopy which showed evidence of ulcerative cystitis and a fistulous tract. Colonoscopy was significant for cobblestone appearing terminal ileum with ulcerated mucosa. Biopsies showed crypt abscess formation and distortion consistent with Crohn’s ileitis. Patient was initially placed on Ciprofloxacin and metronidazole with no improvement in symptoms. MR enterography (MRE) showed the presence of an entero-vesicular fistula with associated distal ileal inflammation. The patient was started on Adalimumab induction dosing followed by 40 mg subcutaneously every other week. Over the course of 4 months the patient reported complete resolution of all symptoms. Re-evaluation with cystoscopy was notable for no residual fistula and MRE approximately 8 months later demonstrated no evidence of an entero vesicular fistula. Enterovesicular fistulas occur in 2%–5% of patients with Crohn’s disease. When present, typical symptoms include recurrent urinary tract infections, pneumaturia and fecaluria. Surgical management is often necessary but can have serious complications such as perforation and abscess formation in as many as 12% of patients. In patients in whom medical management is attempted, there have been limited reported cases of successful closure of enterovesicular fistulas with anti TNF agents. These 2 cases represent the only reported sustained successful management of enterovesicular Crohn’s fistulas confirmed by both clinical response and radiographic evidence on anti-TNF therapy. The early use of anti-TNF in a patient presenting with a fistula (“top-down” approach) may be the reason fistulas healed so effectively. Use of anti-TNF therapy should be considered early in the treatment of fistulizing Crohn’s to include enterovesicular fistulas.

Association of Pyuria and Clinical Characteristics With the Presence of Urinary Tract Infection Among Patients With Acute Nephrolithiasis

Pyuria is a useful indicator of urinary tract infection among patients with compatible symptoms; however, its utility has not been adequately investigated among patients with acute nephrolithiasis. Therefore, we examine performance characteristics of pyuria and other clinical and laboratory correlates for urinary tract infection among patients with acute nephrolithiasis. A single-center prospective observational study examining the performance characteristics of pyuria and other clinical correlates for urinary tract infection was conducted among patients older than 17 years and presenting with acute nephrolithiasis confirmed by computed tomography and for whom urine culture was obtained. Of 360 patients with acute nephrolithiasis, 28 (7.8%) had urinary tract infection, defined as growth of a single uropathogen at greater than or equal to 10(3) colony-forming units/mL. For the presence of urinary tract infection, pyurialevel greater than 5 WBCs/high-power field (hpf) had a sensitivity of 86% and specificity of 79%; greater than 20WBCs/hpf had a sensitivity of 68% and specificity of 93%. In 307 patients who lacked history of fever or measured temperature greater than 37.9°C (100.2°F), pyuria level greater than 5 WBCs/hpf had a sensitivity of 79% and specificity of 81% for urinary tract infection; greater than 20 WBCs/hpf had a sensitivity of 57% and specificity of 94%. Patients with urinary tract infection more often were female; had a history of dysuria, frequent urination, chills, urinary tract infection, or subjective fever; or had measured temperature of greater than 37.9°C (100.2°F). About 8% of patients presenting with acute nephrolithiasis have urinary tract infection, in many without clinical findings of infection, and pyuria has only a moderate accuracy in identifying urinary tract infection in this setting. Clinical features of urinary tract infection, a greater degree of pyuria, and female sex increases the likelihood of infection.

A Painful Right Testis: A Case Report

A 46-year-old Indian male without any medical history presented in the Emergency Department with a painful right testis; the pain radiated toward both flanks. Palpation of the testis was painful. There was no history of dysuria, unsafe sexual contact or weight loss. Diagnostic imaging using ultrasound revealed a suspicious mass lesion in the right testis of 2.2 cm diameter. The serum tumor markers alpha-fetoprotein and beta-HCG were negative, and LDH levels were normal. The patient was referred to the urology department, and a radical orchiectomy was performed. Histopathological analysis showed an adenomatoid tumor of the testicular parenchyma. No involvement of epididymis or testicular membranes was identified. Patient follow up was done every 6 months, consisting of physical examination and scrotal ultrasound. No new symptoms were present after 9 months follow up. J Med Cases. 2013;4(4):212-214 doi: https://doi.org/10.4021/jmc1068e

A Case of Renal Failure Requiring a Renal Transplant Secondary to Lithium Treatment

A Case of Renal Failure Requiring a Renal Transplant Secondary to Lithium Treatment

Primary Malignant Melanoma of the Female Urethra

We report here on a rare case of primary malignant melanoma of the female urethra. A 69-year-old female presented at our hospital with a several month history of dysuria, poor stream, gross hematuria, intermittent blood spots, and a painful mass at the external urethral meatus. The physical examination revealed a soft, small, chestnut-sized lesion through the urethral orifice. The mass was tan colored, ulcerated, covered with necrotic tissue, and protruded from the external urethral meatus. The mass was removed by wide local excision under spinal anesthesia. The pathological diagnosis was malignant melanoma of the urethra. Computed tomography of the abdomen as well as a whole-body bone scan showed no evidence of metastasis. The patient has been free of disease for 6 months postoperatively. We discuss the clinicopathologic features and treatment of this tumor.

P3-S1.20 Aetiology of urethral discharge syndrome and its association with sexual practices among males attending STI clinics in India

BackgroundStudies to validate the aetiology of urethral discharge (UD) syndrome are limited in India. The objectives of the study were to determine etiological agents of UD syndrome among males attending...

Antibody-mediated rejection presenting as allograft hydronephrosis

An 18-year-old boy underwent living-donor renal transplantation. His mother was the donor. The patient was started on tacrolimus (0.1 mg/kg/d), prednisolone (20 mg/d) and azathioprine (2 mg/kg/d), after initial 3 days of I.V. methyl prednisolone (15 mg/kg/d), as immunosuppressive regimen. Six months after transplantation, he presented with fever that had occurred for two days. There was no history of dysuria, altered urine colour, pyuria or edema. Serum creatinine increased from 1.0 mg/dl to 1.9?2.8?3.7 mg/dl over the next 3 days. On the day of admission, serum tacrolimus levels, blood and urine cultures, and search for polyoma virus were ordered. A Doppler ultrasound of the renal allograft artery revealed a resistive index of 0.9 and hydronephrosis, which had not been present on any of the previous ultrasound exams. A CT scan of the abdomen, with an empty urinary bladder, confirmed hydronephrosis of the allograft, with possible pelvic ureteric junction obstruction (Fig. 1). Blood clots, a technically poor ureteral implantation and ureteral are common causes of obstruction in the early post operative phase, whereas periureteral fibrosis, lymphocele and calculi are possible causes in the late post-operative phase. On the same day, the renal transplant surgeon reviewed the operation protocol notes and confirmed that an antireflux procedure, the Lich reimplantation, had indeed been performed. The radionuclide micturition cystography did not reveal vesicoureteral reflux. Ureteric stenosis due to polyoma virus–associated nephropathy (PVAN) was provisionally diagnosed. However, it is known that PVAN typically induces stenosis in the distal rather than the proximal part of the ureter [1, 2]. On day two, the polyoma virus DNA was found to be negative in both urine and blood. Blood and urine cultures were also sterile. Serum tacrolimus levels were found to be 1.8 ng/l. Circulating donor-specific antibodies determination was unfortunately not available in our hospital. The allograft biopsy was done, under ultrasound guidance, and it revealed neutrophils in the capillaries and in the interstitium, diffuse acute tubular injury and C4d positivity in peritubular capillaries. PVAN may be differentiated from acute antibody-mediated rejection (AMR), but not from acute cellular rejection, by the presence of mononuclear and plasma cell infiltration. After renal transplantation, the ureter receives its entire blood supply from the ureteral branch of the renal artery [3]. Acute rejection involves both the kidney and the ureter, and the resulting edema and possible secondary ischaemia may also lead to ureteral obstruction [3]. In an animal model, Hricak et al. [4], found significant alterations in the ureteral dynamics during rejection, as shown by the progressive decrease in electrical activity of the ureteral muscle on electromyography and the reduced G. Swarnalatha R. Ram (&) B. H. Santosh Pai V. Ramesh K. V. Dakshinamurty Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad 082, India e-mail: ram_5_1999@yahoo.com

A Blow-out

A 51-year-old man had symptoms that suggested a pair of common diagnoses, but in fact, a rare phenomenon was at work. He presented to the emergency department with a 5-day history of right-sided flank pain, right-sided lower chest pain, and cough with expectoration of yellow sputum. On review of systems, he reported that he had been experiencing fatigue and decreased urine output for 1 month. He had no history of dysuria, hematuria, or significant medical problems, aside from a previous surgery for peptic ulcer disease 10 years earlier.

Which one is true bladder?--a giant urinary bladder diverticulum

A previously healthy 73-year-old man visited our clinic for 2 weeks history of dysuria and nocturia. Physical examination revealed a palpable mass, sized 12 cm without tenderness, over the supra-pubic area. Digital examination of the rectum detected an enlarged, non-tender prostate deviated to right aspect. The laboratory findings were unremarkable. Abdominal ultrasonography showed a large cystic mass after micturition. The subsequent computed tomography (CT) scan …

Recurrent Abdominal Pain in Childhood Urolithiasis

Our goal was to establish the clinical presentation and features of pain attacks in children with recurrent abdominal pain (RAP) and urolithiasis. We compared the rate of previous appendectomy among 100 consecutive patients with that of 270 control subjects. We also compared the frequency of pain attacks with that reported by children with functional or organic gastrointestinal RAP. Fifty-three patients had no history of dysuria or gross hematuria, and only 35 had hematuria at the first visit; 41 patients were evaluated for urolithiasis only because of a family history of kidney stones associated with RAP. Twenty-nine patients had been previously hospitalized for abdominal symptoms. Sixteen patients and 4 control subjects (1.5%) had undergone a previous appendectomy (P < .0001). Two to 28 months before the diagnosis of urolithiasis, 37 patients underwent abdominal ultrasonography, which did not show urinary stones. Sixty-nine percent of subjects younger than 8 years of age had central/diffuse abdominal pain. The mean frequency of pain attacks was 4 to 9 times lower than in patients with functional or organic gastrointestinal RAP. Because of the inconstant occurrence of dysuria and hematuria, the location of pain in areas other than the flank, and the lack of calculi shown on imaging studies performed after pain attacks, the urologic origin of pain may be overlooked and ineffective procedures performed. The possibility of urolithiasis should be considered in children with RAP who have a family history of urolithiasis and/or infrequent pain attacks, even when dysuria and hematuria are lacking, and in younger children even when pain is not lateral.

Calcified Ventricular Aneurysm

Left ventricular aneurysm (LVA) is defined as a distinct area of abnormal left ventricular diastolic contour with systolic dyskinesia or paradoxical bulging. A False aneurysm is defined as a rapture of the left ventricular wall enclosed by a surrounding pericardium, with an incidence rate of 10-35% of developing a myocardial infarction, depending on methods used for diagnosis and definition. 1,2 A 70 year old male patient was presented at Sultan Qaboos University Hospital in Salalah with a history of increasing shortness of breath and a cough producing a white coloured sputum over the last 2 weeks prior to admission. The patient also had a history of orthopnea and paroxysmal nocturnal dyspnea for the 2 days prior to admission. For two years prior to admission, the patient had experienced shortness of breath on performing ordinary activities, and swelling of both legs over the last 2 months. However, the patient had no chest pain, no palpitation, no dizziness, no chest pain on effort and no history of dysuria. The patient was known to suffer from Coronary Artery Disease and experienced a myocardial infarction (MI) 10 years back where a coronary artery bypass surgery (CABG) was performed. The patient also had a history of diabetes and hypertension but was on irregular treatment and irregular follow up. On admission, the patient was dyspnoic, and his complexion had turned earthy in colour. The patient was also presented with bilateral leg oedema, raised JVP, his BP was 140/80, PR was 90 B/min, temp was normal at 37oC, normal heart S1, S2 and systolic murmur. Chest bilateral basal crepitation and abdomen palpable liver were also observed.

An Unusual Case of Non-Functioning Crossed Renal Ectopia Without Fusion

An Unusual Case of Non-Functioning Crossed Renal Ectopia Without Fusion

Malakoplakia in the Urinary Bladder of a Kitten

Malakoplakia is a form of chronic granulomatous inflammation that in humans most commonly affects the urinary bladder of middle-aged women. Naturally occurring malakoplakia is rare in animals, having been described twice in the pig only. An 8-week-old kitten was diagnosed with malakoplakia of the urinary bladder after a 3-week history of dysuria. Post-mortem examination revealed a markedly enlarged bladder with a diffusely nodular mucosal surface. Microscopically, there was diffuse submucosal infiltration by histiocytes stained positively by periodic acid Schiff (PAS) and described in the human condition as "von Hansemann cells". Intracellular and extracellular "Michaelis-Gutman" inclusion bodies were seen on light and electron microscopical examination. These structures are considered pathognomonic for malakoplakia. The pathogenesis of malakoplakia is enigmatic. Defective function of phagolysosomes is currently suspected to underlie the abnormal accumulation of submucosal histiocytes; however the primary functional defect remains unknown.

Case 2: An unusual cause of urinary symptoms

A 3.5-year-old Mexican-American boy presented to the emergency department with a three-month history of increasing dysuria, voluntary urinary retention and ‘dribbling’. The pain was described as severe, and was localized to the penis and periumbilical area. His mother reported that he had cried on urination since infancy, and although doctors in Mexico had recommended a circumcision, the procedure was never performed. He was otherwise asymptomatic, without fevers or gastrointestinal symptoms. He avoided liquids in an effort to minimize urination, consuming less than 1 L a day. After refusing to urinate for as long as possible, he would exhibit overflow incontinence for several hours. There was no history of prescription or over-the-counter medication use. Past medical history was otherwise unremarkable. Neither his three older siblings nor his parents exhibited similar symptoms at the time. The child’s paternal grandmother had a history of nephrolithiasis resulting in renal failure and nephrectomy. His father had a history of dysuria as a child, for which he was circumcised without further incident. Review of systems was unremarkable. Physical examination revealed an anxious but well-appearing boy. His vital signs were normal, and his height and weight were at the 40th percentile. Abdominal palpation did not elicit pain, and no masses were detected. There was no “flank” tenderness. His rectal tone was normal, as was the neurological examination of the legs. The penis was uncircumcised without any gross abnormalities of the foreskin or urethral meatus. The penis was not tender to palpation, and the foreskin was easily retractable. Initial laboratory studies included a normal complete blood count, albumin, phosphate, blood urea nitrogen and creatinine. The chemistry panel revealed a normal anion gap acidosis with a sodium of 135 mmol/L, potassium of 3.3 mmol/L, chloride of 106 mmol/L and bicarbonate of 17 mmol/L. This acidosis resolved itself over the course of hospitalization with intravenous hydration. Urine was collected by catheterization, and urinalysis revealed 3+ leukocyte esterase, positive nitrites, pH of 6.5, 1+ protein, 3+ blood, 25 to 50 white blood cells/high power field, eight to 25 red blood cells/high power field, no casts and many bacteria. Urine culture grew greater than 100,000 colony forming units/mL of Escherichia coli, Morganella morganii and Enterococcus faecalis. Further investigation elucidated the underlying problem.

Primary non-hodgkin lymphoma of urinary bladder with nine years later renal involvement and absence of systemic lymphoma: A case report

Primary bladder non-Hodgkin lymphoma (PBNHL) is very rare, especially as extranodal B-small lymphocytic lymphoma (B-SLL). Also, late isolated renal manifestation of PBNHL is extremely unusual. We report a very rare type of extranodal B-SLL of bladder wall with extremely unusual late isolated renal involvement, clinically manifested by nephrotic syndrome and incipient renal failure. A 56-year-old woman was presented with a solitary tumor of bladder wall, with history of dysuria and night sweating. A transvaginal needle biopsy of the tumor was performed, and diagnosis of primary extranodal B-SLL was made in the absence of bone marrow, lymph node, or blood involvement. She was treated with chemotherapy until the achievement of complete remission. Nine years later, she developed nephrotic syndrome. The renal biopsy revealed parenchymal lymphoma's involvement associated with glomerular lesion. Immunohistochemical analysis confirmed the same imunophenotype of lymphoma cells like in bladder wall nine years ago. Restaging procedure showed no evidence of disease elsewhere. To our knowledge, it is the first case of association of very rare primary bladder B-SLL with late isolated renal involvement.

Diverticulosis Presenting as Recurrent Bacteremia

Purpose: We present a case of a 71 year old man with a past medical history of diverticulosis who presented with one month history of dysuria, lethargy and fever. Work up initially showed multiple organisms in the urine; however his blood cultures in 2 bottles grew proteus mirabilis. The patient was treated with IV antibiotics and after improvement; he was transferred to the geriatric rehabilitation unit. Subsequently, the patient developed multiple episodes of UTI and bacteremia. Urinary obstruction secondary to an enlarged prostate was initially suspected, however, the patient started to report foul smelling urine and pneumaturia. CT scan of the abdomen showed the possibility of a fistula between a diverticulum in the sigmoid colon and the bladder with no evidence of diverticulitis. The patient had no clinical history suggestive of previous episodes of diverticulitis. Colonocopy was done and malignancy and IBD were ruled out. Cystoscopy confirmed the presence of the fistula. Patient underwent successful surgical treatment. Conclusion: Colovesical fistula (CVF), first described by Cripps in 1888, is caused by various inflammatory or neoplastic processes. Diverticulitis is the most common underlying cause, followed by carcinoma, radiation, Crohn's disease and ruptured appendix Diverticulosis is a rare but important cause of CVF. In patients with recurrent UTIs and other symptoms of CVF, Diverticulosis should be ruled out.

Emphysematous cystitis

A 70-year-old poorly-controlled type 2 diabetic male presented with a 48-hour history of dysuria, frequency and frank haematuria. He described a 6-week history of worsening bladder outflow obstructive symptoms with nocturia and hesitancy. On examination he had a temperature of 37.5°C and tenderness in the left iliac fossa. Digital rectal examination revealed a tender, smoothly enlarged prostate gland. Blood glucose measurement was significantly elevated at 17 mmol/litre and serum white cell count was elevated at 19×109/litre, demonstrating a marked neutrophilia. A plain film of the abdomen demonstrated the presence of a well-defined area of lucency in the region of the bladder suggestive of air within the bladder wall. A large lucent area was also noted in the left lower quadrant suggestive of a large bladder diverticulum distended with air (Figure 1). Based on these findings, a diagnosis of emphysematous cystitis was considered likely and the patient was commenced on broad-spectrum intravenous antibiotics, intravenous fluids and subcutaneous insulin sliding scale. Subsequent computed tomography of his abdomen and pelvis with intravenous and oral contrast confirmed the presence of emphysematous cystitis with a markedly abnormal, thick-walled bladder as well as air within the bladder wall (Figure 2). The large lucency seen in the left lower quadrant on plain film was shown on computed tomography to represent a 9.7 cm bladder diverticulum, also containing air within its wall (Figure 3). There was no evidence of a colovesical fistula. Urine culture demonstrated a significant growth of Escherichia coli. His clinical course was uneventful and he was discharged home well 7 days later on oral antibiotics for a total of 14 days. He is due for further investigation of his lower urinary tract symptoms with cystoscopy.

Renal failure after cardiac surgery

A 52 year old non-smoking black man presented with a two week history of dysuria, malaise, fever, and rigors. In the past he had had recurrent urinary tract infections requiring antibiotic treatment. On clinical examination he had a temperature of 38.9°C, his pulse rate was 70 beats/min, and blood pressure was 125/70 mm Hg. A pansystolic murmur was auscultated, which was loudest at the apex beat and radiated to the left axilla. Urine dipstick was positive for protein and blood. Laboratory investigations showed a haemoglobin concentration of 9.7 g/dl (normocytic), white cell count of 12.2 ¥ 109/l (neutrophil count 8.8 ¥ 109/l), C reactive protein of 106 mg/l, erythrocyte sedimentation rate of 130 mm in the first hour, raised corrected calcium (2.73 mmol/l), and a total protein count of 113 g/l. Renal …