Perineal Discomfort Research Articles

Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients

Levofloxacin is a synthetic fluoroquinolone that is usually used to treat chronic bacterial prostatitis. We investigated the safety and efficacy of levofloxacin compared with ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. This was a multicenter, open-label, randomized controlled non-inferiority trial. Four hundred and seventy-one patients with clinical symptoms/signs were enrolled into the study, and 408 patients were microbiologically confirmed chronic bacterial prostatitis, who were randomized to either oral levofloxacin (500mg q.d.) or ciprofloxacin (500mg b.i.d.) for 4 weeks. Bacterial clearance rate, clinical symptoms/signs, adverse reactions and disease recurrence were assessed. The clinical symptoms and signs (including dysuria, perineal discomfort or pain) and bacteria cultures in 209 patients treated with levofloxacin and 199 patients treated with ciprofloxacin were similar. The most common bacteria were Escherichia coli and Staphylococcus aureus. One to four weeks after the end of 4 weeks treatment, the bacterial clearance rate (86.06% vs. 60.03%; P<0.05) and the clinical efficacy (including clinical cure and clinical improvement(93.30% vs. 71.86%; P<0.05)) were significantly higher in the levofloxacin-treated group than in the ciprofloxacin-treated group. The microbiological recurrence rate was significantly lower in the levofloxacin-treated group than in the ciprofloxacin-treated group (4.00% vs. 19.25%; P<0.05). Rates of adverse events and treatment-related adverse events were slightly lower in the levofloxacin-treated group than in ciprofloxacin-treated group. Levofloxacin showed some advantages over ciprofloxacin in terms of clinical efficacy and disease recurrence, with a low rate of adverse events, for the treatment of chronic bacterial prostatitis in Chinese patients.

Diagnosis and treatment of seminal vesicle cysts

Aim: To deepen the understanding of patients with seminal vesicle cysts for correct diagnosis and treatment.Patients and Methods: Five patients with seminal vesicle cysts were treated over the period January 1996–May 2010. Their symptoms, diagnostic results, treatment and outcomes were analysed retrospectively. The mean age of these patients at diagnosis was 35 years (range: 20–45). Symptoms included haematospermia in three patients, urinary frequency in three patients, perineal malaise in four patients, infertility in three patients, pain after ejaculation in three patients, scrotal pain in three patients and dysuria in one patient. Cysts were palpable in four patients on digital rectal examination. All patients underwent intravenous urography and cystoscopy. Some patients received ultrasonography, computed tomography (CT) scanning, magnetic resonance imaging (MRI) or vasovesiculography. The size of the masses ranged from 3.8 cm × 3 cm × 2.6 cmto approximately 9.6 cm × 5.2 cm × 5 cm. Final open surgery consisted of vesiculectomy in two patients and laparoscopic excision of a partial seminal vesical cyst in three patients.Results: The postoperative course was uneventful, except for one patient who complained of ureter pain. All patients were free of symptoms after open surgery.Conclusions: Seminal vesicle cysts are rare, but should be considered in men with haematospermia and otherwise inexplicable bladder irritation symptoms, perineal discomfort or other genitourinary complaints of unknown aetiology. Diagnosis consists of digital rectal examination, transrectal and abdominal ultrasonography, CT scanning and MRI. Laparoscopic excision of seminal vesical cysts produced excellent results.

1076 COMPARISON OF PROSTATIC ABSCESS TREATMENT IS TRANSURETHRAL RESECTION OF PROSTATIC ABSCESS MORE EFFECTIVE THAN NEEDLE ASPIRATION?

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20121076 COMPARISON OF PROSTATIC ABSCESS TREATMENT IS TRANSURETHRAL RESECTION OF PROSTATIC ABSCESS MORE EFFECTIVE THAN NEEDLE ASPIRATION? Seung Hwan Lee, Dae Hun Lee, Dong Hoon Lee, Kyung Kgi Park, Mun Su Chung, and Byung Ha Chung Seung Hwan LeeSeung Hwan Lee Seoul, Korea, Republic of More articles by this author , Dae Hun LeeDae Hun Lee Seoul, Korea, Republic of More articles by this author , Dong Hoon LeeDong Hoon Lee Seoul, Korea, Republic of More articles by this author , Kyung Kgi ParkKyung Kgi Park Seoul, Korea, Republic of More articles by this author , Mun Su ChungMun Su Chung Seoul, Korea, Republic of More articles by this author , and Byung Ha ChungByung Ha Chung Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1183AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to know the effective treatment of prostatic abscess among conservative treatments, transurethral resection of prostatic abscess, and transrectal ultrasound (TRUS)-guided needle aspiration in 52 cases over a 10 year period. METHODS Between January 2000 and September 2010, the records of 52 patients diagnosed with prostatic abscess were retrospectively reviewed. Multivariate regression analysis was done to determine independent risk factors for the length of hospitalization in patients with prostatic abscess. RESULTS The mean age at diagnosis was 56.9 years old, the mean volume of the prostate was 47cc, the mean PSA was 16.3ng/ml, and the mean prostatic abscess size was 3.8cm. The mean hospital stay was 17.5 days .19 patients had hypertension (36.5%), 22 had diabetes mellitus (42.3%), and 7 (13.5%) had paraplegia due to spinal cord injury. The most common symptoms were fever (90.4%), perineal discomfort (82.7%), dysuria (76.9%), and urinary retention (55.8%). Conservative treatment in 11 cases, transurethral resection of prostatic abscess in 23 cases, and TRUS-guided needle aspiration in 18 cases was done respectively. Prostatic abscesses were recurred in 4 cases (22.2%) after needle aspiration within 1 month. And 2 patients performed conservative treatment died due to sepsis. On multivariate regression analysis, age, history of diabetes mellitus, and treatment method of prostatic abscess are the independent factors which affect the average hospitalization period. CONCLUSIONS Considering the mortality of prostatic abscess, transurethral resection of the prostatic abscess is the most effective method to reduce the time period of hospitalization and recurrence. Significant predictors of hospital stay in patients with prostatic abscess Variables Standardized regression coefficient (R) P value Age 0.492 0.035 DM (yes) 2.124 0.042 Hypertension (yes) 1.016 0.122 Treatment methods TURP=0 2.293 0.033 Conservative treatment =1 TURP=0, Needle aspiration=1 2.428 0.026 Conservative treatment =0 1.168 0.137 Needle aspiration=1 Urine analysis 0.215 0.079 Leukocytosis 0.172 0.099 Abscess size 0.113 0.189 Prostate volume 0.095 0.245 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e437 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seung Hwan Lee Seoul, Korea, Republic of More articles by this author Dae Hun Lee Seoul, Korea, Republic of More articles by this author Dong Hoon Lee Seoul, Korea, Republic of More articles by this author Kyung Kgi Park Seoul, Korea, Republic of More articles by this author Mun Su Chung Seoul, Korea, Republic of More articles by this author Byung Ha Chung Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment of Prostatic Abscess: Case Collection and Comparison of Treatment Methods

PurposeProstatic abscess is an uncommon urologic disease but has a high mortality rate if not treated properly. Furthermore, diagnosis and proper treatment of prostatic abscesses remains a challenge for physicians. Therefore, we compared data on conservative treatments, transurethral resection of prostatic abscess, and transrectal ultrasound (TRUS)-guided needle aspiration in 52 cases over a 10-year period.Materials and MethodsThe records of 52 patients diagnosed with prostatic abscess by computed tomography at Gangnam Severance Hospital between January 2000 and September 2010 were retrospectively reviewed. All patients were discharged when their leukocytosis had normalized and they had been free of fever for 2 days. Multivariate regression analysis was done to determine independent risk factors for the length of hospitalization.ResultsAt the time of diagnosis, the average age of the 52 patients was 61.3 years (range, 33 to 81 years), the average volume of the prostate was 56.3 ml (range, 21 to 223 ml), the average prostate-specific antigen was 18.54 ng/ml (range, 2.0 to 57.0 ng/ml), and the average abscess size was 3.8 cm (range, 2.1 to 5.5 cm). All patients were treated with parenteral antibiotics during their hospital stay with intravenous antibiotics (fluoroquinolone monotherapy or 3rd-generation cephalosporin in combination with an aminoglycoside). Of 52 patients, 22 had diabetes mellitus (42.3%), 19 had hypertension (36.5%), and 7 (13.5%) had paraplegia due to spinal cord injury. The most common symptoms were fever (47, 90.4%), perineal discomfort (43, 82.7%), dysuria (40, 76.9%), and urinary retention (29, 55.8%). Prostatic abscesses were treated by conservative treatment (11 cases), transurethral resection of prostatic abscess (23 cases), and TRUS-guided needle aspiration (18 cases). The average hospitalization stay was 17.5 days (range, 6 to 39 days); that of conservative treatment patients was 19.1 days (range, 9 to 39 days). Patients treated by transurethral resection of prostatic abscess and TRUS-guided needle aspiration stayed 10.2 days (range, 6 to 15 days) and 23.25 days (range, 18 to 34 days), respectively. Of the 18 cases who underwent needle aspiration, prostatic abscesses recurred in 4 cases (22.2%) within 1 month after patient discharge. The 2 patients subjected to conservative treatment died due to sepsis. We found no independent factors that affected the average hospitalization period.ConclusionsPatients with prostatic abscess treated by transurethral resection of the prostate had a significantly shorter hospitalization length compared with needle aspiration.

The practice of episiotomy in a university teaching hospital in Nigeria: How satisfactory?

Background : Episiotomy is essentially a surgical procedure but it is often relegated to the least experienced member of the obstetric team with possible untoward consequences to the mother. Aim : This study set out to appraise how episiotomy was practiced in the University of Calabar Teaching Hospital during the period of the study. Materials and Methods : It was a cross sectional exploratory study which assessed episiotomy and episiorrhaphy procedures among parturients in the centre. Results : Thirty two percent of the 275 parturients studied did not know what episiotomy means. The majority (61.5%) of the parturients were not counseled on the need for episiotomy before the procedure was performed on them. The mean delivery-repair interval for episiotomy among parturients in the study population was 17.9 + 5.66 minutes. Most (75.6%) of the episiotomies were performed by midwives. A significant proportion (45.8%) of the parturients had episiotomy performed on them without prior administration of local anaesthesia. The majority (52.7%) of the episiotomies were repaired by house officers. Common complications among women in the study population were perineal discomfort, perineal pain and difficulty in breastfeeding. Conclusion : The practice of episiotomy in the studied University Teaching Hospital during the period of the study did not meet all necessary requirements of a surgical procedure. Senior members of the obstetric team should supervise the practice in order to ensure the maintenance of standard. Keywords : Episiotomy, episiorrhaphy, surgical procedure, practice, counseling

Episiotomy pain relief: Use of Lavender oil essence in primiparous Iranian women

Introduction Post-episiotomy discomfort and its consequences can affect maternal quality of life and mental health as well as the mother and baby relationship. Complementary medicine is increasingly used and Lavender oil is frequently prescribed due to its antiseptic and healing properties. Method This clinical trial involved 60 qualified primiparous women admitted for labor in Kamali Hospital in Karaj, Iran. They were randomly categorized into two groups: case (using Lavender oil) and control (usual hospital protocol). Participants pain and discomfort were recorded using a Visual Analogue Scale (VAS) and a Redness, Edema, Ecchymosis, Discharge Scale (REEDA). Pain was evaluated at 4 h, 12 h and 5 days following episiotomy. Collected data was analyzed in SPSS 14 using an independent t-test and chi-square. Results There was a statistical difference in pain intensity scores between the 2 groups after 4 h ( p = 0.002, and 5 days ( p = 0.000) after episiotomy. However, differences in pain intensity between the two groups, at 12 h post-surgery, were not significant ( p = 0.066). The REEDA score was significantly lower in the experimental group (Lavender oil group) 5 days after episiotomy ( p = 0.000). Conclusion According to these findings, use of Lavender oil essence can be effective in reducing perineal discomfort following episiotomy. It is suggested that Lavender oil essence may be preferably to the use of Betadine for episiotomy wound care.

Midwives’ support for Complementary and Alternative Medicine: A literature review

There is evidence that the use of Complementary and Alternative Medicine by childbearing women is becoming increasingly popular in industrialised countries. The aim of this is paper is to review the research literature investigating the midwives' support for the use of these therapies. A search for relevant research published from 2000 to 2009 was undertaken using a range of databases and by examining relevant bibliographies. A total of thirteen studies were selected for inclusion in this review. The findings indicate that the use of Complementary and Alternative Medicine is widespread in midwifery practice. Common indications for use include; labour induction and augmentation, nausea and vomiting, relaxation, back pain, anaemia, mal-presentation, perineal discomfort, postnatal depression and lactation problems. The most popular therapies recommended by midwives are massage therapy, herbal medicines, relaxation techniques, nutritional supplements, aromatherapy, homeopathy and acupuncture. Midwives support the use Complementary and Alternative Medicine because they believe it is philosophically congruent; it provides safe alternatives to medical interventions; it supports the woman's autonomy, and; incorporating Complementary and Alternative Medicine can enhance their own professional autonomy. There is considerable support by midwives for the use of Complementary and Alternative Medicine by expectant women. Despite this enthusiasm, currently there are few educational opportunities and only limited research evidence regarding CAM use in midwifery practice. These shortfalls need to be addressed by the profession. Midwives are encouraged to have an open dialogue with childbearing women, to document use and to base any advice on the best available evidence.

Management of Recalcitrant Bladder Neck Contracture After Radical Prostatectomy for Prostate Cancer

Management of Recalcitrant Bladder Neck Contracture After Radical Prostatectomy for Prostate Cancer

The 1 year outcome of the transobturator retroluminal repositioning sling in the treatment of male stress urinary incontinence

To evaluate the efficacy and safety of a transobturator retroluminal repositioning sling suspension in the treatment of male stress urinary incontinence (SUI) after prostate surgery. In 118 men with SUI after prostatic surgery, a transobturator retroluminal repositioning sling suspension was implanted. Patients were evaluated including: complete history and physical examination, 24-h pad test, a questionnaire (International Consultation on Incontinence Questionnaire, Short-Form), urodynamic evaluation and endoscopy. The surgical technique was described previously. The findings before and at 1 year after sling placement were compared. At the 12-month follow-up, 73.7% of the men were cured, 16.9% were improved, and 9.3% were still incontinent. After sling placement the daily pad use decreased significantly (P < 0.001), while the ICIQ-SF improved significantly (P < 0.01). The detrusor voiding pressure, postvoid residual urine volume and maximal flow rates remained unchanged, while the Valsalva leak-point pressure improved significantly (P < 0.01). In 19.5% of the men, there was transient scrotal pain or perineal discomfort. In 5.1% of the men, postoperative urinary retention occurred but resolved spontaneously after a few weeks of catheter placement. In 1.7% of the men adductor pain was reported, which resolved spontaneously. There were no major complications. The transobturator retroluminal repositioning sling suspension for the treatment of male SUI is effective and safe with a low complication rate after 1 year of follow-up.

Care and consequences of perineal trauma

This article discusses the care and consequences of perineal trauma which affects the majority of women. It is clearly evident from the literature that failure to recognize the extent of trauma, incorrect repair and inadequate pain relief can lead to negative consequences in both the short and long term. Women complain of varying degrees of perineal pain and discomfort and pain relief is an important aspect of midwifery care. It would appear that a combination of systemic and localized treatments is necessary to achieve adequate pain relief which will meet individual women's needs.

Perineal discomfort in prostatic adenocarcinoma

We highlight the risk of missing a high-grade (Gleason Grade 7/8) transition zone adenocarcinoma in a patient presenting with perineal discomfort on sitting.

Chronic prostatitis presenting with dysfunctional voiding and effects of pelvic floor biofeedback treatment

To investigate the features of chronic prostatitis presenting with dysfunctional voiding (DV) and the effects of pelvic floor biofeedback (PFB). The study included 21 patients, diagnosed by having symptoms for > or =3 months, including urinary frequency and urgency, voiding difficulty, upper abdominal or perineal discomfort, and with a score of > or =1 on the first and second part of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Patients with bacterial prostatitis, urethritis, interstitial cystitis, urethral stricture and neurogenic bladder were excluded. All patients had a urodynamic examination, to assess the uroflow curve, maximum urinary flow rate (Q(max)), maximum detrusor pressure during the storage phase (P(det.max)), maximum urethral pressure (MUP) and the maximum urethral closure pressure (MUCP) were recorded. PFB was carried out in patients with non-neurogenic detrusor sphincter dyssynergia, and the effects evaluated after 10 weeks. Before and after PFB treatment the mean (sd) Q(max), P(det.max), MUP, MUCP were 8.2 (4.1) vs 15.1 (7.3) mL/s, 125.1 (75.3) vs 86.3 (54.2) cmH(2)O, 124.3 (23.3) vs 65.4 (23.0) cmH(2)O and 101.5 (43.6) vs 43.5 (16.7) cmH(2)O, all significantly different (P < 0.05). The respective differences in the pain, urination and life impact subdomain scores, and total scores, of the NIH-CPSI were 4.0 (2.0) vs 2.2 (1.7), 7.9 (2.1) vs 2.2 (1.9), 9.6 (2.7) vs 2.9 (2.6) and 21.7 (4.8) vs 8.4 (4.6), and all differences were significant (P < 0.05). There might be DV in patients with chronic prostatitis and lower urinary tract symptoms. Urodynamics showed a low Q(max) and increasing intravesical pressure and, in some patients, increasing urethral pressure. Urodynamics could be used to help in the diagnosis, and to select the most appropriate treatment. PFB had satisfactory short-term effects on these patients.

¿Qué pacientes con incontinencia de esfuerzo tras prostatectomía radical se benefician de la indicación de invance®?

Stress urinary incontinence alter radical prostatectomy is one of the most worrisome sequelae for the patient and urologist. The aim of this paper is to evaluate the indications of the suburethral mesh Invance, giving details on our preoperative evaluation and indication, surgical technique, and the correlation between preoperative findings and functional results. Between February 2006 and January 2009 27 patients underwent surgery. All of them had more than one year of follow up after prostatectomy, urodynamic study and preoperative cystoscopy. Continence was evaluated by the number of pads/day and the ICIQ-UI SF questionnaire. Through a perineal incision three titanium screws with a polipropylene suture were inserted in each ischiopubic rami, and a silicon/polipropylene mesh (Invance) is affixed to them, compressing the bulbar urethra. Patients were divided into two groups: good prognosis (1-2 pads/day without urodynamic anomalies in the filling phase) and bad prognosis (3 pads/day, history of radiotherapy or bladder neck incision, and urodynamic anomalies). Cure was defined as a patient not needing pads, and improvement was defined as decrease in the number of pads per day. Median follow up after Invance was 18 months (4-38). Nine patients used one pad/day, 10 used two, and eight used three pads /day. Six cases had underwent previous bladder neck incision and three radiotherapy. Globally, 20 patients (74% ) were cured and five (19% ) had improved. Cure rate was 100% in the good prognosis group and 61% in the bad prognosis group (p=0.03). No intraoperative complications were registered. During the immediate postoperative period,one patient required cystostomy tube for 10 days. Seven patients (26% ) presented perineal discomfort; neither de novo urgency nor urethral erosion nor sling explants due to infection were registered. Invance is a safe technique that guarantees a high continence rate in selected patients. It is a reproducible operation and, with a midterm follow up, no loss of continence has been observed, and the risk of urethral erosion is null in our experience. Patients with mild-moderate incontinence, without urodynamic anomalies nor previous radiotherapy are the ideal candidates.

Safety of lavender oil in the treatment of perineal trauma

Essential oil therapy in wound care is gaining increasing popularity. This largely consumer-driven trend is currently being incorporated into the care of postnatal women experiencing perineal discomfort. Anecdotal evidence suggests that some midwives recommend the use of perineal pads pre-spotted with an essential oil blend containing lavender oil. Currently, the topical use of essential oils as a complementary therapy for perineal wound management is not underpinned by empirical evidence. A review of the existing literature on lavender oil in wound care has been conducted in an attempt to explore the safety of current practices. This review highlights that currently there remains limited evidence to support the direct topical use of pure lavender oil as an effective and safe treatment or comfort measure upon the perineum.

The countermoeasure to handle the postoporative complications of procedure for prolapse and hemorrhoids with reusable homorrhoid stapler

Objective To analyze the reasons of postoperative complications of procedure for prolapse and hemorrhoids with reusable hemorrhoid stapler and evaluate the countermeasure of preventive handle.Methods To retrospectively analyze the clinical data and postoperative complications of 107 cases hemorrhoid patients treated with PPH from January 2006 to December 2008 in our department,at the same time to analyze and summarize the reasons of postoperative complications of procedure for prolapse and hemorrhoids and countermeasure to handle.Results The average operation time was 14 rain.The Average resident date was 4 days.The short-term postoperative complications include:32 cases anus uncomfortable(30.0%),25 cases anus severe pain(23.4%),19 cases urinary retention(17.8%),6 cases remain cutaneous tag(5.6%),5 cases rectal tenesmus(4.6%).Postoperative bleeding was not found in any case.A few patients feel abdominal discomfort and perineal region discomfort,which relieve in progress without any privilege,Long-term postoperative complications include 2 cases stoma stenostomia(1.9%),take a favorable turn by enlarging anus.After follow-up 5～36 months,anus infection,copracrasia,palindromia and rectovaginal fistula were not found in any case.Conclusion Reusable hemorrhoid staplers are satisfactory when using in the PPH.The stapler could he used repeatedly and cost less.Thus,they are acceptable and worthy to promote. Key words: Procedure for prolapse and hemorrhoid; Complications; Hemorrhoid; Stapler

Preperitoneal repair of inguinal hernia at open radical prostatectomy

Patients undergoing prostatectomy for cancer are at risk for onset/worsening of inguinal hernia (IH). Preperitoneal inguinal hernia repair (IHR) concurrent with radical prostatectomy (RP) should be considered. Dissection of the preperitoneal space at RP provides an ideal opportunity for the repair of inguinal hernia. We describe our efforts with patients undergoing RP and IHR to determine whether this approach is safe. Records of patients undergoing RP and simultaneous IHR were identified from a prospective prostatectomy database from 1995 to 2007. Clinical hernia presentation, repair techniques, operative time, and complications were recorded. During the study period, 4,311 RPs were performed at our institution. Of these, 108 patients (2.5%) had 141 simultaneous IHRs. The mean patient age was 61 years (range 45-79), with an average body mass index (BMI) of 27.5 (range 19-37.6). Most patients underwent repair of a unilateral IH (n = 75; 69%) and 33 patients (31%) had a bilateral repair. The operative time was a median of 224 min in patients undergoing simultaneous IHR compared with 180 min in patients undergoing RP only. Records of the time required for IHR were available for 21 patients undergoing unilateral repair and for 18 patients undergoing bilateral repair. The median times for unilateral and bilateral IHR were 42 and 33 min, respectively. Only one patient had postoperative complications (perineal discomfort, bilateral neuralgia/paresthesia) possibly related to IHR. There were no wound infections in patients undergoing simultaneous hernia repair. Of the 141 IH repairs, four recurrent hernias (2.8%) required reoperation at a median of 16 months following initial repair. In our experience, preperitoneal IHR at the time of RP should be strongly considered, as it is not associated with an increased risk of complications and adds less than an hour of additional operative time to RP alone.

Atrofia renal izquierda y abocamiento ureteral a vesícula seminal. tratamiento quirúrgico laparoscópico

Renal atrophy with an ectopic drainage of the ureter is an uncommon malformation. Zinder described in 1914 a cystic dilation of the seminal vesicle in association with an ipsilateral renal agenesis. Usually, these patients present lower urinary tract symptoms with perineal discomfort and fever. The most accurate diagnosis is given by the MRI, while CT and ultrasonography are less precise.We present a case of a patient who goes into hospital because of left lumbar pain and urinary sepsis data, whose CT detects an ectopic drainage of the left uereter in the seminal vesicle. He underwent a successful laparoscopic surgical treatment.

A Case of a Large Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis

The diagnosis of seminal vesicle cysts is often delayed or missed as a result of both their rarity and wide spectrum of potentially confusing clinical and imaging findings they can produce. Although rare, they should be considered in men, especially with a history of renal agenesis, who exhibit o inexplicable irritable voiding symptoms, perineal discomfort or other genitourinary complaint of unclear etiology. We introduce such a case, and discuss its symptoms, radiological findings and its therapeutic approach.

Adenocarcinoma arising in the ileoanal pouch after restorative proctocolectomy for familial adenomatous polyposis

Dear Editor, The primary phenotypic feature of familial adenomatous polyposis (FAP) is the development of numerous adenomatous polyps throughout the colon and rectum, which, if left in situ, will inevitably undergo malignant change. Although treatment via proctocolectomy is generally curative and a restorative ileal pouch-anal anastomosis (IPAA) preserves trans-anal defecation, a subsequent development of malignancy in the pouch utterly undermines this effort. In this paper, we present a case of advanced ileal adenocarcinoma arising within such a pouch in a 40-year-old man as a salutary lesson. Our patient was initially referred 10 years ago (February 1997) with a 1-year history of altered bowel habit and rectal bleeding. Colonoscopy revealed a large carpet of adenomata in the rectum and many similar lesions proximally, making clear the diagnosis of FAP despite the lack of an overt family history. He therefore underwent a restorative proctocolectomy with double stapled IPAA and a covering loop ileostomy. Histological examination confirmed extensive dysplasia throughout the colon with an incidental finding of an early invasive adenocarcinoma at the rectosigmoid junction (Dukes A). His early postoperative recovery was hampered by a pelvic abscess which required formal operative drainage. Thorough examination, in addition to pouch irrigation with methylene blue dye, then revealed no deficiency in the pouch or anastomosis and no evidence of communication between the pouch and the abscess cavity. He convalesced thereafter appropriately undergoing closure of the loop ileostomy 11 months after the initial surgery (pouch and anastomosis were again found to be entirely satisfactory at this time). Subsequently, however, the patient represented frequently with recurrent bouts of small bowel obstruction as well as difficulty with pouch emptying. Despite a further laparotomy and full adhesiolysis in 2001, symptomatic episodes continued to bring the patient into hospital regularly leading to repeat laparotomy in April 2002. At this time, an afferent loop of small bowel to the pouch was found to be involved in an inflammatory mass, and it was felt most prudent to transect this loop just above the pouch and bring out the proximal end as an ileostomy. The distal end was closed, and the pouch was left in situ. After this procedure, the patient was well for 5 years, and definitive management of the defunctioned pouch was deferred to allow him to resume his livelihood. However, in March 2007, he developed a new onset of discharge per ano, along with fevers, perineal discomfort and pain extending to the base of his penis. Given the signs of pelvic sepsis and the fact that the pouch had previously failed to function, it was clear that re-laparotomy for excision of the pouch was required. At this operation, the robust dissection necessary to free the pouch released a significant volume of purulent fluid posteriorly. Histology subsequently revealed a moderately differentiated adenocarcinoma extending fully through the pouch muscle wall but surrounded by considerable adenomatous mucosal change. All margins were free of tumour, and there was no evidence of lymphatic invasion microscopically. The presence of tumour perforation was felt sufficient justification, however, for adjuvant chemotherapy postoperatively. Our patient is currently well. Int J Colorectal Dis (2008) 23:329–330 DOI 10.1007/s00384-007-0400-1

Enterobius vermicularis in the male urinary tract: a case report

Enterobius vermicularis is an intestinal nematode of humans. Adults usually have low worm burdens and are asymptomatic. Ectopic infections in the pelvic area or urinary tract rarely occur in women. We report a case of the patient with mild voiding difficulties such as urgency, frequency, nocturia, dysuria, mild low back pain or perineal discomfort. The patient's prostatic secretions showed a large number of inflammatory cells and several eggs. The size and the shape of the eggs identified them as a group of E. vermicularis. On examination we found a soft palpable material which was 5 mm diameter in size and spherical shape. Palpation gave the impression of a tissue than a stone. An incision was performed and a 4 mm long living worm was found. The microscopic examination identified the worm as E- vermicularis. It is an extremely rare manifestation of enterobius vermicularis infection since an intestinal-breeding worm is rarely found in the male genital tract.