Intermittent Urinary Retention Research Articles

A conservative management approach for spinal tuberculosis causing cauda equine syndrome in pregnancy

Background: Spinal tuberculosis in pregnancy leading to neurological sequelae is rare and a challenging condition to manage. The usual approach is to perform urgent decompression surgery, but patients with a more stable course of the disease may benefit from a conservative approach with anti-tuberculosis (ATT) therapy.Case presentation: A pregnant mother in her second trimester presented with a history of chronic backache exacerbated by right-sided foot drop, L5 root sensory loss and intermittent urinary retention. MRI revealed L5 vertebral collapse with para-vertebral collection causing cauda equine compression at the L5-S1 level. High ESR, strongly positive tuberculin test, and the clinical and radiological findings were compatible with a diagnosis of spinal tuberculosis. Based on the multi-disciplinary team’s decision, a conservative management approach with ATT and supportive therapy was initiated with close observation. The patient showed a remarkable response to ATT with clinical and radiological improvement. She underwent an elective caesarean section at 37 weeks and delivered a healthy baby. On the fourth week postpartum, she underwent decompressive surgery with complete neurological recovery,Discussion and conclusion: Spinal TB in pregnancy causing neurological impairment is usually managed with urgent surgical interventions. This is one of the few reported cases where a conservative approach was undertaken, with close observation and a positive outcome.Therefore, it is important to carefully select patients needing surgical interventions and those who would benefit better from a conservative approach. High suspicion, early diagnosis, prompt treatment initiation and close monitoring are vital components in achieving the best outcome.

Unusual cause of urinary retention in an infant

Introduction: Gastrointestinal tract duplication cysts constitute a rare group of malformation. Patients with presacral mass present with a diagnostic challenge due to the less obvious presentation. Case Report: We report a 7-month-old boy, who presented with constipation and acute intermittent urinary retention. On per-rectal examination, a palpable mass was felt posteriorly with a narrow base, raising a query of pre-sacral/pelvic mass. Ultrasound pelvis revealed a well-defined, rounded oval-shaped cystic mass noted in the center of the lower pelvis, posteriorly. Computed tomography (CT) scan abdomen confirmed a cystic pelvis mass anterior to the rectum causing mass effect. Magnetic resonance imaging (MRI) of the pelvis was done to define its relationship to the sacral spine. A high-intensity lesion was seen on T2 imaging with no spinal involvement. Hence surgical exploration was done, and per operative diagnosis of rectal duplication was confirmed. Postoperatively child was discharged on the fourth post-operative day and doing well on follow-up. Conclusion: We emphasize a complete examination, including per rectal examination in any child presenting with acute urinary retention to exclude pre-sacral masses.

Neurogenic Bladder: A Rare Autonomic Sign in a Patient With Preserved Speech Variant (Zappella Variant) Rett Syndrome

Background: Rett syndrome is characterized by the loss of speech and purposeful hand movements, ambulation problems, and typical hand stereotypies. Preserved speech variant Rett syndrome (Zappella Variant) is a much less common form where speech is relatively preserved, from words to simple sentences. Lower urinary tract dysfunction and neurogenic bladder due to autonomic involvement have been only rarely reported in Rett syndrome. We aimed to emphasize neurogenic bladder due to autonomic dysfunction, which has very rarely been reported in the literature, in a patient with preserved speech variant Rett syndrome, a rare form of the Rett syndrome. Case presentation: A 7-year-old female patient who had been diagnosed with severe vesicoureteral reflux and neurogenic bladder when 11 months old due to the inability to urinate was suspected of suffering from Rett syndrome after intense eye contact and the stereotypic movement of hand wringing were observed. The patient could talk with phrases and walk and had purposeful hand movements. The presence of the c.961C>T (p.Arg321Trp) mutation in the C terminal region of the MECP2 gene was demonstrated with Sanger sequencing. The patient is currently 13 years old and is receiving special education and continues to be monitored for chronic renal disease at the pediatric nephrology department. Conclusion: The presence of hand stereotypies and intense eye pointing could indicate the Zappella variant Rett syndrome in a female patient who has developmental problems, can talk, has purposeful hand skills. Rett syndrome patients can also have lower urinary tract dysfunction although this is less common than cardiac, respiratory and gastrointestinal autonomic involvement. The development of intermittent urinary retention and vesicoureteral reflux may be associated with neurogenic bladder caused by autonomic involvement should be considered in these patients and one must be aware of the complications.

Unveiling the Uncommon: Acute Urinary Retention in Second Trimester Pregnancy due to Retroverted Uterus - A Self Case Report

Acute urinary retention (AUR) during pregnancy is a rare yet significant complication, particularly when it occurs in the second trimester due to retroverted uterus. This case report sheds light on this unusual phenomenon, clinical implications, diagnostic approaches, and management strategies. A 27-year-old primigravida at 12 weeks' gestation experienced intermittent urinary retention. Foley catheterization relieved an acute episode, evacuating 1.2 liters of urine. Recurrent AUR required intermittent catheterization and probiotics. Gynecological examination and ultrasonography confirmed a retroverted uterus as the cause. Over four weeks, the patient improved, with the uterus repositioning anteriorly by the 16th week, leading to spontaneous resolution. This case highlights the rarity of second-trimester AUR due to retroverted uterus during pregnancy. The interplay of anatomical variations and physiological changes can result in unusual clinical presentations. Swift intervention, including Foley catheterization and patient positioning, achieved successful resolution. Elevated clinical awareness and personalized management are vital for unique pregnancy challenges.

Clear cell adenocarcinoma of the male urethra: a case report

BackgroundPrimary urethral cancer in males is rare. Clear cell adenocarcinoma is more rare. We report a case in an African male suspected to have a urethral stricture.Case presentationA 66-year-old man presented in with preceding intermittent haematuria and acute urinary retention. Failed attempts at catheterisation necessitating a suprapubic catheter insertion raised the suspicion of a urethral stricture. Multiple irregular urethral filling defects were seen on a retrograde urethrogram. Urethroscopy revealed obstructing urethral masses. Histology reported clear cell adenocarcinoma.ConclusionPrimary urethral cancer should be entertained as a differential diagnosis of a urethral stricture in a patient with haematuria, difficult urethral catheterisation and ambiguous urethrogram findings. Cystoscopy and biopsy are essential in the investigative work-up to make the distinction.

A PAX-8-positive Female Urethra Adenocarcinoma: A Case Report with Diagnostic Challenges in Intestinal- Type Adenocarcinoma

Abstract Introduction/Objective Female urethra adenocarcinoma (FUA) in women is extremely rare, representing 0.02% of all women’s cancers and <1% of cancers in the female genitourinary tract. Intestinal-type primary adenocarcinoma of the urethra is even rarer, with only one documented case to our knowledge. Furthermore, PAX-8 immunoexpression in this entity has not been reported. Here we report an intestinal-type primary urethral adenocarcinoma that developed from inflammation-related metaplasia in urethral diverticulum with positive PAX-8 staining. Methods Clinical chart review and microscopic examination on the lung, urethral, and vaginal wall biopsies and immunohistochemistry were performed. Results A 64-year-old female with a 32-pack-year history of tobacco use was found to have multiple pulmonary nodules on imaging. The tumor cells were positive for CK7, CK20, SAT-B2, and PAX-8 and negative for TTF- 1/Napsin and ER. Positive PAX-8 immunoexpression raised the possibility of a gynecologic/Mullerian primary. Subsequent colonoscopy and imaging showed no evidence of colorectal or uterine tumors. The patient began having hematuria with intermittent urinary retention, and cystoscopy showed a 4 x 3 cm mass involving bladder neck circumferentially and invading into the vaginal wall. Urethral and vaginal tumor biopsies were performed. Morphologic examination of the urethral biopsy demonstrated intestinal metaplasia of squamous mucosa with transition from a mature to dysplastic phenotype where the adenocarcinoma originated from. The vaginal wall biopsy showed the same morphology. The urethral and vaginal wall biopsies showed a similar immunophenotype as the pulmonary nodule biopsy. Conclusion FUA is a rare, aggressive tumor that occurs in Skene’s glands. In our current case, however, it appeared to arise from inflammation-related metaplasia in urethral diverticulum. Another important finding of the case is the positive PAX-8 expression. Therefore in PAX-8 positive tumors, primary adenocarcinoma of lower urinary tract should be in the differential, along with gynecologic/Mullerian tumors.

Prostate Artery Embolization Used in the Management of Transfusion-Dependent Hematuria After Prostatic Urethral Lift Procedure in a Patient with Thrombocytopenia: A Case Report.

Background: The prostatic urethral lift (PUL) procedure is a novel therapeutic method to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). Gross hematuria after this procedure has been reported to be mild and transient. This report highlights a case of refractory transfusion-dependent hematuria after the PUL procedure in addition to its management with selective prostatic arterial embolization (PAE). Case Presentation: A 78-year-old Caucasian man with a history of myelodysplastic syndrome, thrombocytopenia, and intermittent urinary retention secondary to BPH underwent a PUL procedure. Before the procedure he received a platelet transfusion making his platelet count 58,000/μL. The day after the procedure he was admitted to a hospital for gross hematuria with clot retention. He was started on continuous bladder irrigation and taken to the operating room for clot evacuation and fulguration of prostate. His thrombocytopenia and anemia were managed with transfusions. He was treated with desmopressin, aminocaproic acid, and intravesical 1% alum without improvement. He returned to the operating room for clot evacuation in addition to photoselective vaporization of the prostate laser ablation of the prostatic fossa. He eventually required a total of four transurethral fulgurations without improvement in transfusion-dependent hematuria. Ultimately, resolution of the hematuria was achieved through bilateral PAE with Embosphere® Microspheres performed by interventional radiology. He was discharged home 2 days after the embolization procedure without recurrence of hematuria or urinary retention at a 6-month follow-up visit. Conclusion: The PUL procedure has been shown to be an effective alternative to more invasive surgical options for LUTS caused by BPH. Despite careful consideration in an attempt to alleviate urinary retention, PUL still resulted in significant bleeding in this patient with thrombocytopenia. This is the first report to highlight the use of bilateral PAE as a method for achieving control of severe refractory hematuria after PUL.

Multi-Segmental Intramedullary Epidermoid Cyst Causing Low Back Pain and Urologic Dysfunction

Introduction: Epidermoid cysts (ECs) are rare, slow growing tumors which usually affect lumbosacral area as an extramedullary lesion and mostly associated with spinal malformations. In this report we describe a very rare case of multi-segmental intramedullary EC. Case Presentation: A 42- year-old male presented with low back pain and paresthesia of left lower limb and also intermittent urinary retention. Urodynamic study showed weak contractions in bladder. MRI demonstrated multi-segmental lobulated intramedullary lesion extending from C7 to L2, which has high intensity on both T1 and T2-weighted images. Laminectomy of T11-L3 for symptomatic parts of the lesion and subtotal resection of the tumor was performed and histopathological investigation confirmed EC. Conclusions: Prompt evaluation of every patient with combination of neurological and urologic disturbances should be carried out. This report suggests that rare intraspinal tumors such as EC may affect multiple locations of the spinal cord, thus appropriate surgical intervention may prevent unwanted sequelae.

Small bowel through the canal of nuck causing urinary retention

The differential diagnosis of indirect inguinal hernia in women can be a challenge to the surgeon as symptoms can vary from chronic pelvic pain to even a palpable labial mass. Indirect inguinal hernia is usually congenital, and a patent canal of Nuck can complicate a hernia with hydrocele. Contents of the hernia sack include small bowel, part of the urinary bladder, or an ovary. This is a case report of an indirect inguinal hernia in a 57-year-old woman presented as a labial mass that caused intermittent urinary retention for a year before she decided to seek medical attention. After a CT scan that confirmed the diagnosis of hernia, the patient underwent a herniorrhaphy with a plug mesh. The sack contained small bowel. After the herniorrhaphy the urinary symptoms disappeared. In conclusion, an inguinal hernia can present as a labial mass causing urinary symptoms without including the bladder or ureter.

Congenital urethral polyps in children: Report of 18 patients and review of literature

Background/PurposeTo evaluate the presentation, diagnosis and management of congenital urethral polyps (CUP) in children and to report the results of the endoscopic resection of polyp with long-term follow-up. MethodsBetween April 1995 to March 2010, 18 children (14 boys, 4 girls) with CUP were treated. The most common presentation was urinary outflow obstruction/retention, hematuria or protruding polyp from the urethra meatus in girls. Six patients presented with vesicoureteral reflux (VUR). All children (except one) underwent a transurethral resection of the CUP. ResultsFollowing the endoscopic resection of the polyps, there was no polyp recurrence, and all patients became symptom-free. The children exhibited no reflux, urinary retention, hematuria or urinary tract infection (UTI) following endoscopic management. Abnormal uroflowmetry patterns returned to normal following the resection of the polyp for one year after the operation. ConclusionsUrethral polyps must be considered in every child with history of triad of recurrent intermittent urinary retention, hematuria and lower urinary tract symptoms. The cure can be achieved in all cases by an endoscopic approach. This type of tumor is always benign and very rarely recurs, unless the pedicle stalk is not resected. The endoscopic management of reflux is unnecessary in this group of patients due to their natural history of secondary reflux.

Leiomyoma as a cause of urinary retention

Urinary retention is uncommon in reproductive age women. The frequent causes for obstructive retention are pelvic masses and a history of surgery. We report a case of intermittent urinary retention caused by a leiomyoma. A 47-year old patient with voiding difficulties for the past four months was referred to the gynecology outpatient clinic. She had urinary retention and had been catheterized several times for bladder emptying. She had been evaluated by the urology clinic and a cystoscopy was performed with normal findings. Magnetic resonance imaging (MRI) revealed a pelvic mass at the anterior uterine wall with a diameter of 10 cm. Her physical examination confirmed the MRI findings. Total abdominal hysterectomy was performed with a complete resolution of the patient’s complaints. Women with urinary retention should be consultated with a gynecologist in order to rule out pelvic masses.

1865 URINARY SYMPTOMS IN YOUNG WOMEN: COMPARING ORAL CONTRACEPTIVE PILL(OCP) USERS AND NON-USERS

Improvement in Stamey score of 1 grade was achieved in 75.4% (107/142) at 1 year, in 75.6% (68/90) at 2 years, in 84.9% (62/73) at 3 years and in 92.9% (39/42) at 4 years. Dry rate (PPWT 2 gms) was 51%, 62% and 74%, and 77% and 50% improved rate was 80%, 86%, 83% and 89% at 1, 2, 3 and 4 years, respectively. IQoL increased from 36.8 (SD 23.1) at baseline compared to 70.0 (SD 25.5), 71.7, 74.1 and 80.6 at 1, 2, 3 and 4 years. Optimal continence was achieved with a mean of 3 adjustments. Mean balloon volumes were 3.9 ml (1.0–11.5 ml). Device or procedure related complications (bladder perforation, port or balloon erosion, balloon migration, port or balloon related discomfort, intermittent urinary retention) were reported in 25% (39/ 156) of subjects at the end of 12 months, 19% (22/116) through year 2, 11.1% (10/90) through year 3 and 13.2% (3/22) through year 4. Of these, the majority were considered to be mild in severity. At 4 years 29 patients had undergone permanent explants of both devices, 43 were lost to follow up and 6 had died of unrelated causes. CONCLUSIONS: Four year data suggest ACT is a simple, safe and minimally invasive effective treatment for recurrent female SUI.

Oral Poster 20

OBJECTIVES: Evaluate the safety and efficacy of the ACT® device for the treatment of recurrent SUI. Secondary objectives included procedural technical difficulty and device adjustability. MATERIALS AND METHODS: Management of stress urinary incontinence (SUI) associated with intrinsic sphincter deficiency (ISD) can be challenging after prior failed therapies. The Uromedica ACT® system is a novel device under FDA investigation that provides bulk at the bladder neck with adjustable silicone balloons for urethral coaptation and bladder neck support. Each balloon is attached to a titanium port allowing for post-operative titration of the balloons for maximal efficacy. A small incision between the labia majora and minora at the level of the urethral allows for passage of a trocar under fluoroscopic guidance to the bladder neck. The device is delivered and the balloon filled with 1.5 cc dilute contrast. The injection port for balloon adjustment is placed into a subcutaneous pouch in the labia majora. Balloon adjustments begin 6 weeks post-operatively, as needed. The study population involves female patients with recurrent SUI with urethral hypermobility (UHM) and/or intrinsic sphincter deficiency (ISD). Testing was performed at baseline, then postop 6 wks, 3, 6, 9, 12 months, and annually thereafter, and included urinalysis, a 3-day diary, provocative pad weight test (PPWT), direct visual stress test (DVST), Stamey score, physical exam and validated questionnaires (UDI-6, IIQ-7, IQoL). RESULTS: : 162 patients were implanted to date, with 142, 84 and 57 patients completing at least 1, 2, and 3 years follow-up, respectively. Mean age is 67.4 yrs (range 31–94 yrs). 83% (N = 135) had at least one previous anti-incontinence procedure, with 42.6% experiencing 2 or more failed procedures. Difficulty of ACT® surgery was rated as mild, moderate, or severe in 62%, 29%, and 9% of procedures, respectively. Improvement in Stamey score was >1 in 75.4% (107/142), in 75.0% (63/84) and in 83.9% (47/56) at 1, 2 and 3 yrs, respectively. Mean PPWT decreased from 48.9, 44.3 and 44.5 grams at baseline to 11.8, 8.9 and 8.4 grams at 1, 2 and 3 yrs, respectively (P < 0.001). Dry rate was 50.8%, 63.0% and 71.4%, and >50% improved rate was 79.7%, 88.7% and 83.3% at 1, 2 and 3 yrs, respectively. Validated questionnaires noted significant improvements at 1, 2 and 3 yrs (P < 0.001). Mean number of balloon volume adjustments through the study period to achieve maximum continence was 2.9 (0–15). Device or procedure related complications (bladder perforation, port or balloon erosion, balloon migration, port or balloon related pain/discomfort, intermittent urinary retention) were reported in 25% (39/156) of subjects at the end of 12 months, 18.6% (21/113) through year 2, and 13.7% (10/73) through year 3. Of these, the majority (54%) were considered to be mild in severity. CONCLUSION: 3-year data suggest the Uromedica ACT® system can be an effective, simple, minimally-invasive and safe treatment for recurrent female SUI.

Intermittent Urinary Retention Secondary to a Cervical Leiomyoma

A rare case of intemittent acute urinary retention secondary to impacted posteriorly sited cervical fibroid in a 34 year old nulliparous woman is deescribed. She presented with a two year history of progressive lower abdominal swelling and a one year history of recurrent urinary retention. She had a preoperative diagnosis of impacted posteriorly sited uterine leiomyoma with anterior displacement of the cervix. At laparotomy however, a huge intramural cervical fibroid was found in the posterior part of the cervix measuring 14cm? 12cm extending superiorly to the lower uterine segment and inferiorly into the pouch of Douglas. It completely filled the pelvis and displaced the cervix anteriorly. The uterus was of normal size. A myomectomy with excision of the fibroid was performed. Urinary retention completely resolved after surgery.

Intermittent urinary retention secondary to a uterine leiomyoma

Urinary retention rarely affects reproductive-age women. In obstructive retention, the source must be determined and then removed to allow the patient to void normally. The most common causes of obstructive retention are gynecologic surgery and pelvic masses. Two women with intermittent urinary retention were evaluated in our clinic. Case 1 was a 48-year-old patient who voided frequently to avoid urinary retention. She had an ultrasound showing a large posterior leiomyoma. Case 2 was a 49-year-old female who presented with urinary retention during her menses. Magnetic resonance imaging result showed a large posterior leiomyoma deflecting the cervix anteriorly. Both women's urinary retention completely resolved after a total abdominal hysterectomy. Uterine leiomyomas may be the cause of urinary retention in reproductive-age females without other etiologies.

Intermittent bladder urinary retention in a young woman: an unusual presentation of partial urethral duplication

A singular case of female accessory urethra associated to a mobile bladder stone with an unusual clinical presentation is reported. The role of perineal ultrasound is emphasized as a useful diagnostic tool to study female urethra in a static and dynamic setting, including cases of partial or complete urethral duplication.

BIOFEEDBACK TRAINING FOR DETRUSOR OVERACTIVITY IN CHILDREN

We evaluated biofeedback training for incontinence due to detrusor overactivity in children. Included in our study were 22 boys and 17 girls with a mean age of 11.2 years. We noted nighttime incontinence in 3 patients, nighttime incontinence and daytime urinary symptoms in 26, and daytime incontinence in 10. All patients had detrusor overactivity and incontinence refractory to conventional treatment, including bladder training, tricyclic antidepressants, anticholinergics, desmopressin and/or conditioning therapy. Urodynamic study was performed using an 8Fr double lumen transurethral catheter for cystometry, a double balloon transrectal catheter for rectal pressure and external anal sphincter pressure measurement, and surface electrodes for sphincter electromyography. During biofeedback training patients were instructed to contract the anal sphincter without raising abdominal pressure to inhibit overactive bladder contractions. Biofeedback training was repeated monthly until cystometry revealed a stable bladder or lower urinary tract symptoms improved considerably. Four patients were lost to followup. Of the remaining 35 children urinary symptoms were cured in 23 and improved in 4. Urodynamic studies after 6 months of biofeedback training in 33 cases showed that bladder overactivity disappeared in 10 and improved in 18. Bladder capacity at the initial desire to void and maximum cystometric capacity increased significantly (p = 0.0115 and <0.0001, respectively). Detrusor-sphincter dyssynergia in 2 patients before biofeedback training resolved in each after therapy. Biofeedback training for detrusor overactivity is effective even in pediatric cases refractory to conventional treatment.

The Gut in Anorexia Nervosa: Keep It Moving!

Constipation is one of the well-known physical complications of anorexia nervosa. Contributing to the constipation are an intestinal musculature weakened by starvation, the centrally mediated physiologic "slow-down" of body metabolism in starvation, and the patient's voluntary fluid restriction. Spontaneously arising constipation is exacerbated by medications that have anticholinergic side effects. In anorexia nervosa, constipation can be much more than an inconvenience, as the following example shows: A 16-year-old girl who had anorexia nervosa became badly constipated, with the radiograph showing impacted stool throughout the colon. She suffered many complications, including pain and the development of intermittent urinary retention, brought on first by anticholinergic medications but worsened by fecal constipation.

Transmission of Herpes Simplex Virus Type 1 Infection in Rugby Players

Skin infections, both bacterial and viral, are endemic in contact sports such as wrestling and rugby football. In this report, we describe four cases of extensive cutaneous herpes simplex virus in players on a rugby team. All players had a prodrome of fever, malaise, and anorexia with a weight loss of 3.6 to 9.0 kg. Two players experienced ocular lesions associated with cutaneous vesicular lesions of the face. A third player, who had herpetic lesions on his lower extremity, experienced paresthesias, weakness, and intermittent urinary retention and constipation. All infected players on the team were forwards or members of the "scrum," which suggests a field-acquired infection analogous to the herpetic infections seen in wrestlers (herpes gladiatorum). Considering the serious sequelae of recurrent herpes simplex keratitis, the traumatic skin lesions in rugby football players should be cultured for herpes virus, and infected individuals should be restricted from playing until crusted lesions have disappeared.

Biofeedback Treatment of Intermittent Urinary Retention

The treatment of a 29-year-old woman with intermittent urinary retention using biofeedback is described and discussed in the context of the pathophysiology of reflux urethral instability and related disorders of micturition. During attempts to train the patient to raise the pitch of an auditory biofeedback signal, which varied directly with intrinsic bladder pressure, evidence appeared for the involvement of sensory neuronal pathways in the disorder. This and other evidence are incorporated within an explanatory hypothesis.