Irritative Voiding Symptoms Research Articles

Female Urethral Clear Cell Adenocarcinoma: A Case Report

A 67-year-old female is referred from gynecology due to irritative voiding symptoms, urethral pain, and a vaginal bulge. On exam, a friable lesion can be seen protruding from the urethral meatus, and can be palpated transvaginally to extend proximal to the bladder neck. Transvaginal biopsy demonstrates clear cell adenocarcinoma.

Lower Urinary Tract Symptoms (LUTS) Related to COVID-19: Review Article

The pandemic of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or Coronavirus Disease 2019 (COVID-19) is still ongoing. The outbreak of this new emerging contagious disease has impacted a wide range of sectors including health and economics. Much information about COVID-19 has been discovered by many laboratories, and action taken in various ways as quickly as possible to inhibit the outbreak. It was found that COVID-19 is a ribonucleic acid virus (RNA virus) that can cause infection among humans. Moreover, it can mutate and spread contagiously mainly through the respiratory system. The most common symptoms are cough and fever. Many patients could develop to either pneumonitis or respiratory failure. The SARS-CoV-2 virus can infect various organs, the main infections being in lungs and rectum. In these cases, many laboratories can isolate the virus from oropharyngeal and nasopharyngeal swab and then apply the reverse transcription polymerase chain reaction (RT-PCR) test to identify the COVID-19 virus. Many of the viral infections can cause cystitis by immunologic response. There is a study that showed the SARS-CoV-2 virus could be isolated from the urine sample. The patients had significant changes in urinary storage for frequency, urgency, and urinary incontinence during infected period, which improved after the disease resolved. Moreover, there is a study that reported that the COVID-19 patients who had the International Prostate Symptom Score (IPSS) scores of 20 to 35 had significantly longer hospital stays, more frequent intensive care requirements, and higher mortality rates. Therefore, physician and medical personnel should be aware of the irritative voiding symptoms that might be the presenting symptoms of COVID-19. Furthermore, as many studies have shown that the virus can be excreted in urine, thus, the virus could be contagious via urinary contamination. Keywords: COVID-19; LUTS, Lower urinary tract symptoms; Viral cystitis

Characterization of Urethral Diverticula in Women.

Urethral diverticulum is a rare, yet important condition for the female pelvic surgeon. We aimed to characterize the women who have been seen for this condition across the three Mayo Clinic locations. Medical record review was performed for patients across all three Mayo Clinic sites (Rochester, Arizona, Florida) that had International Classification of Diseases, Ninth Revision, (ICD-9) and International Classification of Diseases, Tenth Revision, (ICD-10) codes corresponding to urethral diverticulum (ICD-9, 599.2; ICD-10, N36.1). We also performed a review of patients who underwent urethral diverticulectomy via Current Procedural Terminology (CPT) code 53235. Data were available for patients from June 1, 2003, to October 5, 2018. Patients were classified by age, etiology, presenting symptomatology, location, treatment, pathology, and postoperative outcomes. Four hundred forty-seven women met initial coding criteria for urethral diverticula, with 228 women having documented urethral diverticula. The most common presentations were irritative voiding symptoms (93) and infections (92). The most common diagnostic modality was radiographic imaging (198/228) with magnetic resonance imaging accounting for 157 cases. Etiology was unknown in the majority of cases (181/228). Of women who were diagnosed, 172 underwent diverticulectomy with 51 concurrent urethral sling placements. Final pathology demonstrated 2 cases of malignancy. Postoperative follow-up ranged from 0 months to 15 years (mean, 1.4 years; median, 4 months). Forty-three patients had persistent urinary symptoms after diverticulectomy with stress incontinence being the most common. Eight patients underwent subsequent sling placement. Fourteen patients had recurrence. This appears to be the largest reported series on female urethral diverticula, a rare yet important entity that requires special consideration. Most surgical cases found resolution of symptoms after diverticulectomy. Importantly, less than 2% of urethral diverticula were associated with malignancy.

Pseudodiverticulum: A rare late complication of the Boari flap procedure for lower ureteric repair

The Boari bladder flap is a vital tool in the armamentarium of the urologist. It is used to maintain continuity of the urinary system when dealing with diseased segments of the mid and lower ureter. It is, however, associated with long-term complications. We present the case of a 46-year-old woman who developed a rare pseudodiverticulum as a consequence of the procedure. This patient had undergone a right-sided laparoscopic Boari bladder flap for a right distal ureteric stricture secondary to pelvic endometriosis, and presented 10 years later at our urology department with long-standing irritative voiding symptoms and a feeling of incomplete voiding. Radiological and endoscopic investigation revealed the presence of a capacious pseudodiverticulum which was seen on ultrasound to retain a significant amount of urine post micturition and then to empty back into her bladder, strongly suggesting that this was the cause of her sensation of incomplete bladder emptying. She had minimal symptom bother and no recurrent urinary tract infections, calculi or tumour, and it was decided that no further operative management was necessary and that her condition could be managed her conservatively. To the best of our knowledge, this is only the second case describing this rare, long-term complication of a Boari flap. Level of evidence: Level 5.

New Frontiers or the Treatment of Interstitial Cystitis/Bladder Pain Syndrome - Focused on Stem Cells, Platelet-Rich Plasma, and Low-Energy Shock Wave

Interstitial cystitis/bladder pain syndrome (IC/BPS), which is characterized by bladder pain and irritative voiding symptoms, is a frustrating disease without effective treatment. The cause is still largely not understood, although urothelium ischemia/hypoxia, apoptosis, denudation, and infiltration of inflammatory cells are common histopathological findings. The current uncertainty regarding the etiology and pathology of IC/BPS has a negative impact on its timely and successful treatment; therefore, the development of new treatment modalities is urgently needed. Herein, we present advances in our knowledge on this topic and review the potential application of regenerative medicine for the treatment of IC/BPS. This article provides information on the basic characteristics and clinical evidence of stem cells, platelet-rich plasma (PRP), and low-energy shock waves (LESWs) based on a literature review with a search strategy for articles related to IC/BPS, stem cells, PRP, and LESW published in MEDLINE and PubMed. Stem cells, PRP, and LESW, which modulate inflammatory processes and promote tissue repair, have been proven to improve bladder regeneration, relieve bladder pain, inhibit bladder inflammation, and increase bladder capacity in some preclinical studies. However, clinical studies are still in their infancy. Based on the mechanisms of action of stem cells, PRP, and LESW documented in many preclinical studies, the potential applications of regenerative medicine for the treatment of IC/BPS is an emerging frontier of interest. However, solid evidence from clinical studies remains to be obtained.

The Surgical Intervention in Genitourinary Tuberculosis

Introduction: Genitourinary tuberculosis (GUTB) is the leading cause of morbidity and mortality worldwide especially in developing countries. Surgery is an essential management modality in genitourinary tuberculosis when indicated. Objective: This study aims to document the role of surgery for genitourinary tuberculosis according to the organ involved. Materials and Methods: Retrospective review of 33 GUTB cases was done that underwent surgery at department of urology, Bangabandhu Sheikh Mujib Medical University from January 2008 to December 2014. Patient’s baseline characteristics, mode of presentation, organ involvement, investigation, surgical intervention and follow up were studied. Results: Among enrolled patients, mean age at presentation was 31.5 years and 64% (21, 33) were male. The most common presentation was irritative voiding symptoms. Kidney was the most common organ involved in 39% (13, 33) cases, and next common site was bladder in 30% (10, 33) cases. Preoperative bacteriologic diagnosis was confirmed only in 21% (7, 33) cases. A total of 41 surgical procedures were performed as some patients needed more than one procedure. These included 13 endoscopic, 6 temporary diversion, 19 ablative procedures and 3 reconstructive procedures. Post surgical follow up of all the patients were given after 3, 6 and 12 months. Then the patients were followed with RFT and ultrasonography 6 monthly for 3 years and then annually. The intravenous urography and diethylenetriamine pentaacetic acid scan were performed when indicated. Conclusion: Multidrug chemotherapy with judicious surgery when indicated is the ideal treatment. Surgery plays an important role in symptomatic relief and helps to lead a normal life. The results of reconstructive surgery are good and should be done when possible. Rigorous and long term follow up is necessary in patients undergoing reconstructive surgery. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.69-73

Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.

Prostatitis is a common condition which can affect men of all ages; however, it is more frequently experienced in younger men with an initial onset around 40 years of age. The two main presenting clinical features of prostatitis are lower urinary tract symptoms and pelvic pain. Other symptoms might include obstructive or irritative voiding symptoms, ejaculatory pain, and hematospermia. A diagnosis is usually based on the man's history, physical examination, urinalysis, and the two-or four-glass test (also known as obtaining urine specimens before, during, and after prostatic massage). Further investigations may also be performed when considering the differential diagnosis. Prostatitis can result in a significant reduction in quality of life (QOL) and pain can be associated with sexual dysfunction in men. Prostatitis can be classified as four distinct types, namely, type I acute prostatitis, type II chronic bacterial prostatitis, type III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and type IV asymptomatic prostatitis. It is unclear whether type III can be linked in all cases to prostatic involvement therefore the alternate denomination CPPS is used in clinical practice. Furthermore, CP/CPPS is further subclassified as type IIIa (inflammatory), and type IIIb (noninflammatory) which is dependent on the presence of inflammatory cells in prostatic secretions. CP/CPPS is considered when pelvic pain is present for at least three of the preceding 6 months with no other identifiable causes determined. There are several hypothesized causes of CP/CPPS which include: neuropsychological factors, infection, inflammation/autoimmunity, and dyssynergia voiding associated with bladder neck hypertrophy. Given the wide range of potential causes of CP/CPPS, there are many pharmacological interventions available in clinical practice to manage this complex condition. It is important to critically summarize evidence-based recommendations to inform the clinical management of men affected by CP/CPPS (Franco et al., 2019).

Concurrent m\xfcllerianosis of the urinary bladder and the umbilicus presenting with umbilical bleeding: a rare case report and review of the literature

BackgroundMüllerianosis is a very rare neoplasm composed of two or three Müllerian derived tissues (endosalpinx, endometrium and endocervix). We report the first case of concurrent müllerianosis of the urinary bladder and the umbilicus presenting with umbilical bleeding.Case presentationA 43-year-old Asian premesopausal female, gravida 1, para 1, presented with intermittent umbilical bleeding. An umbilical nodule and a bladder tumor on the posterior wall of the urinary bladder were identified. She underwent transurethral resection of the bladder tumor and excision of the umbilical nodule successively. Diagnosis of müllerianosis was confirmed by the histological and immunological features. No tumor recurrence was noted at 6 months of follow-up.ConclusionsMüllerianosis is extremely rare and mainly reported in the urinary bladder, and generally affects women of reproductive age. Despite the common presentations of müllerianosis of the urinary bladder including irritative voiding symptoms, abdominal/pelvic pain and gross hematuria, our rare case had no symptom except umbilical bleeding. The possibility of concurrent bladder müllerianosis should be considered when müllerianosis is found at other location. We suggest a surgical intervention to establish the correct pathological diagnosis because it is essential to exclude malignant neoplasms of the urinary bladder. The majority of patients have a favorable prognosis.

Current Status of Genitourinary Tuberculosis: Presentation, Diagnostic Approach and Management-Single Centre Experience at IGIMS (Ptana, Bihar, India)

Genitourinary tuberculosis (GUTB) is associated with significant morbidity and mortality. As patients with GUTB have no specific symptoms or clinical features, early diagnosis and treatment of GUTB is clinically challenging. The present study assessed the current spectrum of clinical presentation, urinary findings and radiological signs of patients with GUTB. Patients with confirmed GUTB (n???=???53) were analysed for clinical presentation, diagnostic tests and management. Data about demographic details, clinical presentation, urine routine examination, urine acid-fast bacillus (AFB) smear test, urine Mycobacterium tuberculosis culture, routine blood investigations, radiological, cystoscopic and histopathological examinations were recorded for all study patients. Various surgical interventions were performed on the basis of the site involved. After surgical procedure, patients were treated with chemotherapy and followed up for one year to till date. The present study patients were from the age range of 19???75 years with female preponderance. The most common clinical presentation was irritative voiding symptoms (69.81%), haematuria and flank pain (56.60%, each). The most commonly affected organ was kidney (62.26%) following ureter (30.19%), urinary bladder (24.53%), prostate (9.43%) and epididymis (1.89%). The urine AFB smear and urine culture for M. tuberculosis tests were positive in 13.18% and 54.71% of patients, respectively. Surgical interventions were done in majority (75.47%) of patients. Accurate and early diagnosis is vital for the better management of patients with GUTB. Apart from the available course of chemotherapy, surgical intervention is also required for complete management.

Intravesical Migration of an Intrauterine Device (IUD)-Case Report

ObjectiveThe objective of this article is to report the first case of intravesical IUD migration at our clinic and raise awareness of forgotten contraceptive devices and their potential complications. MethodsWe report a case of a 67 year old female who had neglected to remove her IUD for 20 years. She visited our clinic because of recurrent UTI's the previous year. After assessment and clinical investigation it was found that the coil had a late onset migration to the urinary bladder, with calculus formation, causing the patients' symptoms. The encrusted intrauterine device was removed endoscopically after cystolitholapaxy at the operation theatre under anesthesia. ResultsThe patient had an uneventful recovery and her UTI's subsided consequently. ConclusionRecurrent urinary tract infections should trigger further investigation. Gynecological history should be included in this procedure. A history of an unretrieved IUD in a patient with recurrent infections or with chronic pelvic pain and irritative voiding symptoms should raise the suspicion of intravesical migration of the IUD. The management of a migrated IUD is controversial. However, if the IUD is found in the urinary bladder removal is mandatory.

Antibiotics are not necessary during routine cystoscopic stent removal: A randomized controlled trial at UC San Diego.

Introduction:Current American Urological Association (AUA) Best Practice Statement recommends antibiotic prophylaxis for cystoscopy with manipulation, including stent removal; although no Level 1b trials explicitly address prophylaxis for stent removal. We sought to determine the efficacy of prophylactic antibiotics to prevent infectious complications after stent removal.Materials and Methods:Following institutional review board approval, patients undergoing removal of ureteral stent placed during stone surgery were recruited from July 2016 to March 2019. Patients were recruited at the time of stent removal and randomized to treatment (single dose 500 mg oral ciprofloxacin) or control group (no antibiotics). Telephone contact was attempted within 14 days of stent removal to assess for urinary tract infection (UTI) symptoms, antibiotic prescriptions, or Emergency Department visits. Primary outcome was UTI within 1 month of stent removal – defined by irritative voiding symptoms, fever or abdominal pain associated with positive urine culture (Ucx) (>100k colony-forming units/mL).Results:Seventy-seven patients were enrolled, with 58 meeting final inclusion criteria for the analysis (33 treatment, 25 controls). No differences were seen with clinical and demographic variables, except a higher body mass index in the treatment group (P = 0.007). Positive Ucx rate before stone surgery (16.7% vs. 11.8%, P = 0.819) and at the time of stent removal (16.0% vs. 11.1%, P = 0.648) was not significantly different in treatment versus control groups, respectively. Primary outcome: No patients in either cohort developed symptomatic culture-diagnosed UTI within 1 month of stent removal. Of patients with documented phone follow-up (treatment n = 29, control n = 22), only one patient (control) reported any positive response on phone survey.Conclusions:We found a low infectious complication rate regardless of antibiotic prophylaxis use during cystoscopic stent removal. The necessity of antibiotics during routine cystoscopic stent removal warrants possible reevaluation of the AUA best practice statement.

Primary Mucinous Adenocarcinoma of Appendix Invading Urinary Bladder with a Fistula: A Case Report.

An adenocarcinoma of the appendix invading the urinary bladder, which is difficult to be diagnosed before the operation, is an extremely rare disease. Only a few cases have been reported. Here we reported a case of patient diagnosed with the mucinous adenocarcinoma of the appendix invading the urinary bladder. The case reported in this study was a 54-years old man who was admitted due to a 6-month history of intermittent episodes of irritative voiding symptoms of the bladder, and weight loss. The patient did not have any gastrointestinal symptoms. The physical examination, laboratory examination, cytology of the urine, computed tomography and cystoscopy were inconclusive. The partial cystectomy, subsequent exploratory laparotomy and intraoperative frozen analysis revealed the appendiceal mucinous adenocarcinoma with a fistula to the urinary bladder. The appendectomy and the right hemicolectomy with a ileocolic anastomosis, the lymphadenectomy and the partial cystectomy limited to the anterior wall was performed. Six months after operation, the patient was in a good health with no obvious discomfort, no recurrence or distant metastases. The recommended treatment for the adenocarcinoma of the appendix invading the bladder with a fistula formation is as follows: appendectomy, right hemicolectomy with ileocolic anastomosis, lymphadenectomy, partial cystectomy and intraperitoneal hyperthermic chemoperfusion.

Urinary K+ promotes irritative voiding symptoms and pain in the face of urothelial barrier dysfunction

The internal surface of the bladder is lined by the urothelium, a stratified epithelium that forms an impermeable barrier to water and urine constituents. Abnormalities in the urothelial barrier have been described in certain forms of cystitis and were hypothesized to contribute to irritative voiding symptoms and pain by allowing the permeation of urinary K+ into suburothelial tissues, which then alters afferent signaling and smooth muscle function. Here, we examined the mechanisms underlying organ hyperactivity and pain in a model of cystitis caused by adenoviral-mediated expression of claudin-2 (Cldn2), a tight junction protein that forms paracellular pores and increases urothelial permeability. We found that in the presence of a leaky urothelium, intravesical K+ sensitizes bladder afferents and enhances their response to distension. Notably, dietary K+ restriction, a maneuver that reduces urinary K+, prevented the development of pelvic allodynia and inflammation seen in rats expressing Cldn2. Most importantly, intravesical K+ causes and is required to maintain bladder hyperactivity in rats with increased urothelial permeability. Our study demonstrates that in the face of a leaky urothelium, urinary K+ is the main determinant of afferent hyperexcitability, organ hyperactivity and pain. These findings support the notion that voiding symptoms and pain seen in forms of cystitis that coexist with urothelial barrier dysfunction could be alleviated by cutting urinary K+ levels.

Intravesical Extrusion of a Single-Incision Midurethral Sling Anchor With a Simple Transurethral Resection Technique: A Case Report

Single-incision midurethral slings were introduced in 2006 with the goal of providing shorter operative time, less postoperative pain, and decreased rates of injury to surrounding structures (eg, bladder and/or obturator nerve). Although unrecognized bladder injury during SIMS placement is a rare complication, it can lead to irritative voiding symptoms and recurrent urinary tract infections. We present the case of minimally invasive approach to remove an extruded sling.

Practice Patterns of Academic Urologists for Evaluating Microscopic Hematuria-How Well are We Following the Guidelines?

Asymptomatic microscopic hematuria is a common clinical entity that may portend significant urinary tract disease. Guidelines vary in how asymptomatic microscopic hematuria should be evaluated, with the AUA (American Urological Association) guidelines arguably being the most comprehensive. We evaluated the practice patterns of academic urologists with respect to the 2012 AUA asymptomatic microscopic hematuria guidelines. Records of patients who underwent evaluation for asymptomatic microscopic hematuria between 2012 and 2015 were retrospectively examined. The use of imaging, cystoscopy and urine cytology was analyzed. Factors such as age, gender, smoking status, history of nonurological malignancy, history of pelvic irradiation, presence of irritative voiding symptoms, use of anticoagulation, number of red blood cells on microscopic urinalysis and evaluation by an oncology fellowship trained urologist were assessed. Multivariable logistic regression analysis was performed to explore the association between patient or physician factors and adherence to the AUA guidelines. Among 1,049 patients with asymptomatic microscopic hematuria 247 (23.5%) were evaluated in complete accordance with AUA guidelines. Rates of adherence to the guidelines regarding imaging, cytology and cystoscopy were 48.2%, 54.2% and 72.5%, respectively. Much of nonadherence was due to lack of cross-sectional imaging (46.4%) and excessive use of urine cytology (45.8%). Guideline adherence was independently associated with smoking history, irritative voiding symptoms, history of nonurological malignancy and evaluation by a nononcology trained urologist. Overall adherence of urologists to the AUA asymptomatic microscopic hematuria guidelines was suboptimal. Efforts in limiting the use of urine cytology to high risk patients may be the most effective way of improving adherence.

28: How to recognize and de-bulk extruded urethral bulking agent

Current literature regarding extruded Macroplastique, a commonly used urethral bulking agent, is currently limited to case reports. To the best of our knowledge there is no literature or guidelines specifically walking through how to “de-bulk” or remove extruded Macroplastique. First, we aim to make the audience familiar with common adverse effects of Macroplastique injections with focus on the rare side effect of extrusion. Then we will introduce a removal technique we used to safely remove a rare case of extruded Macroplastique. A 49-year-old female presented with pelvic pain and irritative voiding symptoms approximately two years after undergoing transurethral Macroplastique injections for the treatment of stress urinary incontinence. A CT scan for surveillance of prior lung cancer demonstrated an incidental finding of a 1.4 cm periurethral mass. Follow up cystoscopy demonstrated a 5 mm region of extruded Macroplastique along the right urethrovesical junction. The patient desired surgical removal of the extruded bulking agent after extensive counseling. Cystoscopic biopsy forceps were used to first remove the exposed Macroplastique material and then apply gentle pressure adjacent to the erosion site to expose additional material, which was removed. The patient was discharged home on the day of surgery after passing an active voiding trial. Her irritative voiding symptoms improved post-operatively. Although rare, urethral extrusion is a known complication of transurethral Macroplastique injection. This video demonstrates a safe and effective removal method of the extruded material two years after placement.

Incidental bladder cancers found on multiparametric MRI of the prostate gland: a single center experience.

In the era of multiparametric magnetic resonance imaging (mpMRI) of the prostate gland, incidental findings are occasionally discovered on imaging. We aimed to report our experience of detecting incidental bladder cancers on mpMRI of the prostate in asymptomatic patients without irritative voiding symptoms or microscopic or gross hematuria. A retrospective review was performed on a prospectively maintained database of all men who underwent prostate mpMRI at our institution from 2012 to 2018. Patients who were found to have incidental bladder lesions were identified and baseline demographics, imaging and histopathologic data were recorded. All patients with incidental bladder lesion detection on mpMRI, not attributable to extension of prostate cancer, underwent cystoscopy in addition to a biopsy and/or transurethral resection of bladder tumor (TURBT) if warranted on cystoscopy. There were 3147 prostate mpMRIs performed during this period and 25 cases (0.8%) of incidental bladder lesions were detected. These patients did not have any presenting symptoms such as gross or microscopic hematuria to prompt bladder lesion workup. The largest diameter of incidentally discovered bladder lesions ranged from 0.4 cm to 1.7 cm. Of the 25 cases of incidental bladder lesions, five were suspected to be due to prostate cancer invasion into the bladder. Only two of these five patients underwent biopsy, which confirmed prostate adenocarcinoma in both cases. Of the 20 patients without suspected prostate cancer invasion of the bladder, four had no suspicious lesions on cystoscopy to warrant a biopsy. The remaining 16 patients had bladder lesions seen on cystoscopy and underwent a biopsy and/or TURBT. Three of these patients had benign features on pathology (urachal remnant, amyloidosis and inflammation) and the remaining 13 had stage Ta urothelial carcinoma. Seven of these patients had low-grade Ta tumors and six had high-grade Ta tumors. All patients were treated with standard management of TURBT with or without intravesical BCG. There have been no reported cases of recurrence or progression in any of the patients in our cohort at the median follow-up of 26 months (interquartile range,19-40 months). mpMRI of the prostate may yield incidental findings, such as small bladder tumors. Awareness of the possibility of incidental bladder lesions is important as 65% of lesions reported in the bladder, not attributable to extension of prostate cancer, proved to be bladder cancer. This may allow for early intervention for asymptomatic patients with undetected bladder cancer prior to disease progression.

Lower Urinary Tract Symptoms Following Transurethral Resection of Prostate.

Transurethral resection of the prostate (TURP) is the standard surgical therapy for lower urinary tract symptoms (LUTS) due to prostatic enlargement. Following TURP, LUTS may persist in a proportion of patients. Persistent LUTS necessitates proper evaluation and management. In this review, we sought to describe the prevalence, pathophysiology, and predictors of LUTS following TURP, as well as the recommended evaluation and management. Among the different techniques utilized for TURP, the prevalence of postoperative LUTS is similar. The chronically obstructed bladder has been shown to vary in its expression of collagen, tissue factors, and receptors when compared to the normal bladder which could contribute to the pathophysiology of LUTS after TURP. Although androgen receptors exist in the urinary epithelium, the role of sex hormones in LUTS remains obscure. GreenLight laser can lead to postoperative irritative voiding symptoms as a result of tissue necrosis. A large proportion of patients have persistent LUTS following TURP, with similar incidences between different techniques that can be used to perform TURP. LUTS after TURP should be evaluated with a thorough history and physical, including International Prostate Symptom Score, and urine culture to rule out infection. Noninvasive uroflow, post-void residuals, and subsequent urodynamic study or cystoscopy can be utilized as needed. Further research is necessary to be able to more precisely predict the patients who will experience no improvement in or worsening of LUTS following TURP.

Bladder Wall Calcification Following Transurethral Resection of Bladder Tumor and Intravesical Mitomycin C Instillation

In rarely reported instances, the use of intravesical mitomycin C appears to have caused bladder wall calcification. We report two patients treated for non-invasive urothelial carcinoma of the bladder with transurethral resection and mitomycin c instillation. Both of these patients experienced new onset of severe irritative voiding symptoms shortly thereafter. Although one patient com- pleted a six-cycle course of Bacillus Calmette-Guerin (BCG), the other only received one instillation due to symptom severity. On cystoscopy the resection beds appeared calcified and necrotic. Biopsies revealed dystrophic calcification and necrosis without evidence of tumor. Resection of this area led to complete resolu- tion of symptoms and normal healing of the resection site. Our results are consistent with the current hypothesis that these cal- cifications are not related to recurrence or persistence of tumor. Although there have not been reported cases of these calcifica- tions signifying recurrence of tumor, it is important for clinicians to rule out recurrence as a cause for these symptoms. Resection of the area has the added benefit of alleviation of irritative void- ing symptoms encountered shortly after mitomycin c instillation.

Urethral adenocarcinoma with bilateral iliac and inguinal lymph nodes which revelead by urethra ectropion in 67-year-old woman: A case report

We reported a case of urethral adenocarcinoma in a 67-year-old woman who was admitted for difficulty voiding, irritative voiding symptoms, bloody urethral discharge and urinary incontinence. Physical examination was realised by gyneacologist and conclued to urological pathology. Urological examination was showed urethral ectropion which was bleeding. She had no fewer, no pelvic pain even less loss weight. Her general state was satisfactory. The lymph nodes of right side inguinal were felt. Computed imaging was showed involvement of right side bladder and bilateral iliac inguinal lymph nodes. Urethral ectropion biopsy anatomopathological screening was conclued to clear cell adenocarcinoma but CIS lesions were not found. The tumor staging was T3N2M0. A radiotherapy was perfomed. The patient was improvement of voiding symptoms and decrease lymph nodes size. Primary urethral carcinomas are rare pathology especially in the woman. Several histological types exist. However, chemotherapy and radiotherapy are very effective on very advanced stages. This cancer may be revealed by an urethral ectropion in a year-old woman.