Left Lateral Wall Of Bladder Research Articles

Plasmacytoid bladder cancer: a rare case report.

The authors report a case of a patient with locally advanced plasmacytoid urothelial carcinoma (PUC) of the bladder. A 71-year-old man with a history of chronic obstructive pulmonary disease presented with gross hematuria. The rectal examination revealed a fixed bladder base. A computed tomography scan showed a pedunculated lesion arising from the anterior and left lateral bladder wall and extended to the perivesical fat. The patient underwent transurethral resection of the tumor. The histologic examination revealed the presence of muscle-invasive PUC of the bladder. The decision of the multidisciplinary consultation meeting was to do palliative chemotherapy. Thus, the patient could not receive systemic chemotherapy and died 6 weeks after transurethral resection of the bladder tumor. A plasmacytoid variant of urothelial carcinoma is a rare subtype of urothelial carcinoma that has a poor prognosis with a high mortality rate. The disease is usually diagnosed at an advanced stage. Given the rarity of plasmacytoid bladder cancer, treatment guidelines are not clear; therefore, more aggressive treatment may be required. PUC of the bladder is characterized by high aggressiveness, an advanced stage at the time of diagnosis, and a poor prognosis.

INFILTRATING UROTHELIAL CARCINOMA ALONG THE URINARY TRACT OF A YOUNG ADULT

Objective: To present a rare case of infiltrating urothelial carcinoma along the urinary tract on a young adult. Case(s) Presentation: A 39 year old Asian male patient with > 20 pack-year smoking history, came to the hospital with a chief complaint of hematuria and flank pain since two weeks ago. Physical examination revealed Eastern Cooperative Oncology Group (ECOG) Performance Status 1, the right kidney was palpated, no tenderness on fist percussion. Abdominal ultrasound (USG) revealed 1.5 cm and 0.5 cm masses located in the urinary bladder. The CT scan show mass in the bladder was exophytic, > 3 cm in size, and occupying lesion was located on the right posteroinferior and left lateral bladder wall accompanied with dilatation of pelvic calyces and right ureter. Histopathology of the specimen revealed low-grade infiltrating urothelial carcinoma of bladder and right ureter. The pathological stage was pT2NxMx, The patient refused neoadjuvant chemotherapy and surgery. Four months after TURBT, he came with weakness and right flank pain. The patient consent to surgery and underwent the right nephroureterectomy. Histopathology of the specimen showed infiltrating urothelial carcinoma of right kidney, ureter, Gerota fascia with lymphovascular invasion (pT3NxMx). Discussion: Urothelial carcinoma (UC) is commonly arising in the urinary bladder, but it can develop along the urinary tract. Cigarette smoke contains a lot of carcinogenic agents and stimulates DNA damage. Conclusion: Upper tract urothelial carcinoma (UTUCs) is subset of UC with a poor prognosis. Cigarette smoking is the main risk factor that induces DNA damage. 

MP61-02 DETAILED CADAVERIC ANALYSIS FOR PERIVESICAL LYMPH NODES WITH POTENTIAL IMPLICATIONS IN BLADDER CANCER

INTRODUCTION AND OBJECTIVE: Perivesical lymph nodes were added to the 8 edition of AJCC staging for bladder cancer. In pN+ patients, positive perivesical lymph nodes are associated with even worse overall survival. These nodes are inconsistently evaluated at the time of radical cystectomy (RC) and can be difficult to differentiate from perivesical fat. Currently, no studies have detailed the presence or anatomic location of perivesical lymph nodes. The objective was to provide a detailed anatomic evaluation of perivesical lymph nodes. METHODS: Six unembalmed cadavers with no prior pelvic malignancy or surgery were utilized. An open RC was performed on all specimens with wide resection of perivesical tissue and meticulous care to separate the pelvic lymph nodes (e.g.obturator, external iliac) from the specimen. The specimens were fixed in a previously validated lymph node revealing solution for 6 hours. Perivesical tissue dissection in 2 mm slices was performed. Lymph node identification and examination were performed by a board-certified pathologist. Perivesical lymph node size and location in relation to bladder wall was recorded. RESULTS: Gross lymph nodes were identified in the perivesical tissue in 50% (3/6) of the specimens, with a total of 6 lymph nodes identified. The mean lymph node size was 7.5 mm (2-16 mm). The mean distance from bladder wall was 9 mm (3-15 mm). Ten potential anatomic locations for perivesical nodes were developed: urachal, anterior bladder wall, posterior peritoneum, periprostatic/bladder neck, bilateral peripedicle, bilateral periseminal vesicle, bilateral lateral bladder wall. Nodes were identified in the: Right peripedicle (2 nodes), left lateral bladder wall (2 nodes), posterior peritoneum (1 node), anterior bladder wall (1 node) (Table). On histologic analysis, 4 of the 6 (66%) grossly identified lymph nodes had confirmed lymphoid tissue. CONCLUSIONS: In a cadaveric model with meticulous dissection, gross and histologically-confirmed lymph nodes were identified in the perivesical space in half of patients. When present, patients had an average of two nodes that were distributed around the bladder and within 15mm of the bladder wall. This data, as well as the inclusion of perivesical lymph nodes in AJCC staging, argues for thorough evaluation of the RC specimen for perivesical lymph nodes.Source of Funding: None

A Rare Cause of Inguinal Herniation: Urinary Bladder Hernia

Case History Herniation of the urinary bladder into the inguinal canal is rare and constitutes 1–3% of all inguinal hernias. Bladder herniation is usually asymptomatic and is determined incidentally; however, it may rarely present with urinary obstruction symptoms. Here, we described an incidental bladder hernia in a 76-year-old man who is evaluated in radiology department for fever and left-sided flank pain for three days duration. He had no previous history of trauma, medication abuse, surgery or familial bladder disorders. His additional co morbidities included hypertension and diabetes mellitus. There were no remarkable findings on abdominal examination except left side loin tenderness. On evaluation Computed tomography (CT) revealed that a left inguinal hernia with fluid density lesion continuous with left lateral bladder wall. No bowel was contained in the hernia (Figure 1, 2). The inguinal hernia was confirmed as bladder hernia by CT cystogram (Figure 3). Inguinal hernia usually contains the peritoneum that surrounds the abdominal organs. Bowel loops, omentum, or extraperitoneal fat can be detected within the hernia sac in the inguinal canal. However, as in this case, the bladder can also be present within the hernia sac. Early diagnosis with radiological imaging is important to prevent complications during surgery.

EXPERIENCE ON TRANSPERITONEAL LAPAROSCOPIC DIVERTICULECTOMY IN UROLOGY DEPARTMENT HASAN SADIKIN HOSPITAL BANDUNG

Objective: To described our experiences in treating large bladder diverticulum using transperitoneal laparoscopic techniques in Urology Department Hasan Sadikin Hospital, Bandung. Material & method: There were 3 patients with bladder diverticulum due to bladder outlet obstruction. There are 2 males and 1 female patients. The bladder outlet obstruction was caused by BPH in both male patients and urethral stenosis in female patient. The bladder diverticles were located in left lateral bladder wall in 2 patients and right lateral bladder wall in 1 patient. All the patients underwent two stages procedure. Initially, we perform correction of the obstruction. Next stages were transperitoneal laparoscopic diverticulectomy. Result: The operating time was improving in each procedure, with average time was 180 minutes. Drain was removed in 3 days in one patient and 2 days in 2 patients. Cystostomy was removed in POD 14 in all patients. One month post operatively, we performed cystography and all of the patients had a normal result without any extravasation. The patients was discharge on day 7 in one patient and day 4 in 2 patients post operatively, with minimal pain. Until now, patient was still under follow up and no major complication was found. Conclusion: Transperitoneal laparoscopic diverticulectomy is a save alternative for the management of bladder diverticulum with minimal post-operative pain and length of stay.

English

A 60 year old man with recent Inferior wall Myocardial infarction presented with haematuria and burning micturition after 2 days of admission to our hospital. Urologist was consulted and growth on the left lateral wall of bladder with clots found in the ultra-sound. Transurethral resection of bladder tumor was recommended immediately to control the bleeding and also to stabilize the patient. We know that administering Anaesthesia for a non cardiac surgery who had a recent myocardial infarction poses a higher risk of complications. We present our uneventful experience of spinal Anaesthesia in this patient who had undergone transurethral resection of bleeding bladder tumor successfully.

Bladder leiomyoma: case report

Leiomyoma is a benign lesion which represents 0.04-0.5% of bladder tumors. It is more common in females and its peak incidence is between 4th and 5th decades. Surgery is the treatment of choice and adequate results have been previously reported. 38 years old male patient who consulted for chronic pelvic pain syndrome. CT scan showed a 2 cm diameter exophitic lesion at the anterior left lateral bladder wall, which protruded into the perivesical fat. We performed a laparoscopic partial cistectomy locating the tumor and resecting it with simultaneous cystoscopic control, obtaining negative margins. The operative time was 70 minutes with an intraoperative blood loss of 50 ml. Postoperative period was uneventful. Final pathology reported: Bladder wall leiomyoma, without mitosis or atypia. Immunohistochemistry was positive for Actine and Vimentine stablishing diagnosis. Cd 1 17 (c-kit) was negative and ruled out a Gastrointestinal Stromal Tumor. Leiomyoma is bladder's most common benign non epithelial tumor. It represents 35-46% of these lesions with a 2:5 male/female ratio. It origins from the smooth muscle bundles and at the urinary tract the most common localizations are kidney and bladder. Clinical presentation depends on tumor size and localization. Ultrasound is the most useful diagnostic tool and the pathological diagnosis is mandatory. Surgery is the treatment of choice and technique depends on tumor size and localization. The laparoscopic approach seems to be an effective alternative in this group of tumors. Prognosis is good and recurrence is rare.

Malignant paraganglioma of the urinary bladder

Paragangliomas of the urinary bladder is one of the rare tumors and accounts for 0.06% of all bladder tumors. Malignancy is uncommon, occuring in 10–15% of the bladder paragangliomas with less than 20 cases previously reported and determined by its clinical behaviour rather than the histological features. Herein, we describe a case of urinary bladder paraganglioma in a 33-year-old male patient who exhibited with macroscopic painless hematuria. On ultrasonographic examination, a 6 cm × 4 cm mass along the left lateral wall of the urinary bladder was detected. The patient underwent CT examination, which revealed a hyperdense mass with some calcification in it. Also bilateral obturator and iliac lymph nodes measuring up to 2 cm were detected. MR imaging was also performed and again an intense enhancing mass in the left lateral wall of the bladder with bilateral lymph nodes and possible invasion to the seminal vesicles and sigmoid colon was shown. In the laboratory analysis, the 24 h urine vanillylmandelic acid (VMA) level was significantly elevated. During transurethral cystoscopy (TUR) and biopsy a hypertension crisis occured which was controlled by medical therapy. Following histopathologic analysis the diagnosis was established as paraganglioma. The patient has undergone radiation therapy for 2 months and only minimal regression of the tumoral size was observed. Due to the fact that long term follow-up is mandatory for these tumors, the patient is closely being monitored by the urology clinic.

Bladder wall lipoma in patient with irritative voiding symptoms

A 48-year-old man presented with urinary frequency and nocturia. He reported minimal improvement of his symptoms despite treatment with alpha-antagonists. Concurrently, during an evaluation for hip pain, the patient’s family physician obtained a magnetic resonance imaging scanthat incidentally revealed two polypoid lesions within the bladder wall, with properties consistent with adipose tissue (Fig. 1). Cystoscopy demonstrated smooth, yellow, well-circumscribed masses at the anteroinferior and left lateral bladder wall (Fig.

Malacoplakia presenting as a large bladder mass

A woman with a medical history significant for recurrent urinary tract infections and systemic histoplasmosis presented with persistent urinary urgency, frequency, dysuria, a weak urinary stream, and gross hematuria. Renal and bladder ultrasound scanning revealed normal kidneys and a mass within the bladder (Fig. 1). A urine culture grew more than 100,000 Escherichia coli. After the patient’s urinary tract infection was treated, she underwent cystoscopy, which revealed a lobulated, fungating tumor present circumferentially at the bladder neck and at the left lateral bladder wall. It was resected endoscopically, with subsequent resolution of all of her voiding complaints. Histologic examination of the specimen revealed malacoplakia (Fig. 2). She was subsequently treated with an extended course of oral antibiotics. Malacoplakia is characterized histologically by the presence of Michaelis-Gutmann bodies contained within von Hansemann macrophages. This likely represents phagolysosomes that contain partially digested bacterial debris. Malacoplakia occurs typically in immunocompromised patients who experience recurrent E. coli urinary tract infections. It predominates in females and occurs in both the upper and lower urinary tracts. Treatment ranges from antibiotic therapy to endoscopic resection and, in some cases, surgical removal of the organ. Malacoplakia is often mistaken for malignancy on imaging studies and on gross inspection and should be considered as a diagnosis in the type of patient described here.1,2

REOPERATION AFTER COMPLICATED TENSION-FREE VAGINAL TAPE PROCEDURES

A 42-year-old woman was admitted to the hospital with intermittent gross hematuria 1 week in duration, urinary frequency and lower abdominal pain that began 6 months after surgery. She had a history of proved stress incontinence and had been successfully treated with the tensionfree vaginal tape procedure 8 months earlier. Cystoscopy during the primary procedure had not been performed. On physical examination the bladder was mildly tender and the gynecological examination did not reveal any changes. Transabdominal and transvaginal ultrasound was normal. Laboratory evaluation revealed gross hematuria and urine cultures did not yield bacteria. Cystoscopy showed a proliferative lesion with calcifications on the left lateral bladder wall. The lesion was biopsied and afterwards a number of sutures were identified protruding into the lumen of the bladder. Histopathology demonstrated planocellular epithelial focal metaplasia and focal papillomatosis. Attempts to cut and remove these structures with endoscopic scissors and forceps was useless. Transabdominal exploration was performed (fig. 1). With the patient under general anesthesia a lower medial incision was made. A Foley catheter was inserted transurethrally to control urethral and bladder neck position. Following the course of the tape the bladder wall was localized and the lesion point with tape fixed to the wall was excised (fig. 2). Tape was incised bilaterally, simultaneously a U shaped sling under the mid urethra was palpated transvaginally and no changes in its position (no lowering) after cutting the tape were observed. Abdominal ends of the sling were cut, shaved and fixed bilaterally to the inguinal ligaments with 3 interrupting sutures on each side using 1-zero polydioxanone. The sling had optimal tension and the urethra was not elevated after fixation. Histopathological examination of the excised tensionfree vaginal tape with the connective tissue revealed granulomatous inflammatory infiltrate. The patient was discharged home. She was continent without the catheter and had no complications, such as hematuria, infection or voiding disturbances. The patient received a standardized Accepted for publication April 27, 2001.

BLADDER ENTRAPMENT DURING INTERNAL FIXATION OF A PELVIC FRACTURE

A 30-year-old white man was admitted to the emergency room after a motor vehicle accident for left lateral shock. At presentation the patient was hemodynamically stable but he required intubation for light coma. Clinical examination demonstrated extensive ecchymoses over the left side of the body, left lower quadrant guarding and left pulmonary hypoventilation. After ruling out urethral injury catheter placement yielded clear urine and urinalysis was negative. Radiographic evaluation showed a ruptured left diaphragm, fractures of the left hemipelvis (ischiopubic segment, acetabulum and iliac crest), peritoneal effusion and moderate cerebral edema. Emergency laparotomy revealed splenic laceration and diaphragmatic dome rupture, which were repaired. Pelvic hematoma that was also discovered a t exploration remained undisturbed. Initial orthopedic management involved traction of the lower left leg. By day 15 of the hospital course, the patient had recovered neurological function and the acetabular fracture was internally fixed. At the completion of surgery moderate hematuria had developed, which was treated with continuous bladder lavage through a double lumen urethral catheter. Excretory urography with the catheter clamped showed bladder compression by an intrapelvic hematoma. Hematuria worsened 2 days later, requiring endoscopic clot evacuation with the patient under general anesthesia. Bladder inspection at the time was unrevealing due to hematuria and inflammation. To determine the bleeding source retrograde cystography was performed, which suggested incarceration of the left lateral bladder wall at the site of the acetabular fracture (fig. 1). This diagnosis was confirmed by pelvic computerized tomography (CT) (fig. 2). At repeat surgery the pelvic hematoma was evacuated and longitudinal cystotomy was performed. This procedure permitted the localization of invagination of the cystic mucosa, where the bladder wall was incarcerated in the left acetabular osseous defect. The bladder was freed from the fracture site, and a small bleeding branch of the obturator artery was noted, explaining the massive hematuria. Hemostasis was achieved by arterial dissection, clamping with verified hemostasis and then ligature at the involved branch of the left hypogastric artery. The bladder was closed in 2 layers with placement of an indwelling urethral catheter. Convalescence was uneventful.