Suprapubic Pain Research Articles

Hyperbaric oxygen therapy as a treatment option for intractable hemorrhagic cystitis in a pediatric patient: A case report

Hyperbaric oxygen therapy (HBOT) is gaining importance as a treatment modality for hemorrhagic cystitis (HC). At pressures of more than 1 atmospheric absolute, administering 100% oxygen initiates neovascularization and mucosal layer formation and reduces edema. HC is a pathological condition manifested with recurrent hematuria, urinary urgency, and suprapubic pain. HC can be caused by radiation exposure, chemotherapeutic drugs, and viral and bacterial infections. HC is a common sequela after stem cell transplant (SCT). Vascular injury and inflammation of bladder mucosa with the use of certain immunosuppressants and post-SCT is a known condition that leads to HC. HC is classified into two types based on the time of onset of the disease following chemotherapy/radiotherapy: Early and late onset of HC, which appears within 48–72 h and 2–3 months, respectively. HC is one of the approved indications for the administration of HBOT from the Undersea and Hyperbaric Medicine Society. There is scanty evidence of HBOT being effective in pediatric cases of hemorrhagic cystitis; however, the effectiveness of the therapy in a pediatric patient on opioid analgesic and active bladder irrigation was debatable. A case of a 6-year-old male child treated with a haploidentical SCT for X-linked adrenoleukodystrophy, was followed up with post-transplant cyclophosphamide. He developed intractable Grade III HC 2 weeks after transplant. The decision-making in assessing the fitness of this child to undergo therapy and the results achieved are discussed in detail in this paper.

Going against the grain: a case report of an endometriosis in the canal of Nuck

The canal of Nuck is an embryological remnant of the processus vaginalis found in females, and is a potential site for endometriosis seeding. Endometriosis in the canal of Nuck is an exceedingly rare condition. Patients with this condition present with groin swelling or suprapubic pain. We describe a case of a 44-year-old female presenting for left inguinal pain and a lump. Physical examination revealed a 3 cm reducible mass; magnetic resonance imaging (MRI) revealed a 6.2 × 3.0 × 1.7 cm multiloculated cystic structure, extending from the left pelvic region into the left inguinal region near the round ligament. The patient underwent surgical excision of the mass. Pathology revealed a multi-cystic lesion lined with mesothelium cells and a fibrous wall with multiple foci of misplaced endometrial glands and stroma, corroborating a diagnosis of endometriosis in the canal of Nuck.

Primary lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) in the urinary bladder mimicking recurrent urinary tract infection: a case report and literature review

We report the case of a 79-year-old woman with primary lymphoma of mucosa-associated lymphoid tissue (MALT) in the urinary bladder. The patient, with urinary frequency, urgency and suprapubic pain had several emergency room visits due to recurrent urinary tract infection. Both sonogram and cystoscopy identified bladder tumors near the bladder neck. An abdominal contrast-enhanced computed tomography scan revealed a polypoid lesion on the anterior bladder wall without enlarged lymph nodes. Transurethral resection of the bladder tumor was conducted. The pathology report confirmed extranodal marginal zone MALT lymphoma. The clinical stage was IEA. Follow-up imaging reported residual bladder tumors, prompting adjuvant radiotherapy. The patient was treated successfully and was disease-free at the 9-month follow-up visit. Primary lymphoma is an uncommon pathological subtype. Its clinical and radiological differentiation from urothelial carcinoma (UC) can be challenging, but treatment strategies differ significantly. A definitive diagnosis relies on histopathology and immunohistochemistry. Typically, bladder lymphoma has a favorable prognosis, but further research is required to identify the optimal treatment.

Cytomegalovirus infection in transplant patients according to pre-transplant risk in a Hospital in Northeastern Mexico

Abstract Background Cytomegalovirus (CMV) is an important cause of morbidity and mortality in patients who receive a hematopoietic stem cell transplant (HSCT). It is possible to stratify the risk of developing the disease due to this agent according to the serological status of the HSCT donor and recipient. In post-transplant patients, significant T lymphocyte dysfunction occurs, so reactivation of CMV is common, which is why it should be monitored after HSCT. Our objective is to determine the association of CMV infection in post-transplant patients according to pre-transplant risk status. Methods Patients who received HSCT from January 2019 to June 2023 were included, they were classified according to their pre-transplant risk status and CMV infection was diagnosed by performing a viral load on day 30. Results 70 patients with hemato-oncological diseases who received an HSCT were included, a median age of 9 years (0-16) was found, predominance of the male sex (60%), the most frequent type of transplant was haploidentical (82.9 %). Of these, 20 (28.5%) had CMV infection, with pre-transplant risk status mostly high risk (85%), of the low-risk patients (25.7%) 10% had the infection and the very high risk (4.3%) only 5% were reported infected. The period during which the infection occurred most frequently was in the early post-pregnancy stage (66.6%) and the majority received treatment with valganciclovir (95%). Of the patients infected with CMV, 15 (75%) were asymptomatic, and 5 (25%) had associated symptoms, with 2 (10%) presenting with urinary symptoms (dysuria, frequency, suprapubic pain, tenesmus), and 2 (10%) with fever, and 1 hematochezia (5%). Regarding clinical outcomes, 17 patients (85%) presented resolution of the disease, 1 (5%) presented therapeutic failure and 1 (5%) died due to multiple organ failure. Conclusion Due to the high prevalence of CMV infection, it is important to maintain a high index of suspicion of this pathology in this population, with the aim of achieving early diagnosis and timely initiation of treatment.

Post-partum Symphysis Pubis diastasis.

Pubic symphysis is a non-synovial joint, made up of a fibrous cartilage disc connecting the two sides of pubic rami in the midline. During pregnancy under the influence of hormones particularly relaxin, the gap increases by 2 to3mm. When the diameter is more than 10 mm, it is considered as pubic symphysis diastasis. Pregnancy and childbirth are the most common causes of pubic symphysis diastasis followed by traumatic causes. Women with post-partum symphysis diastasis present during puerperium with inability to bear weight owing to severe supra-pubic and groin pain. They have complaint of severe excruciating pain while standing up or to perform any movement involving hip abduction. For the diagnosis, proper history regarding delivery should be sought followed by physical examination and radiological imaging. Most cases can be treated with conservative management which includes- use of analgesia and anti-inflammatory medicines for the pain management and stabilization of pelvis using brace/pelvic belt. Some may benefit from physiotherapy. In extreme cases, operative fixation may be required with the involvement of orthopedic surgeon. Keywords: post-partum symphysis diastasis; pubic symphysis; rare presentation.

Double Dose versus Standard Dose of Tamsulosin with Solifenacin for Treatment of Ureteric SRS (Stent Related Symptoms)

Abstract Background Ureteral stents provide drainage of the upper urinary tract, when obstruction of the ureter is present or anticipated. Indicated in relieving urinary obstruction, following or prior to ureterorenoscopy, Prophylactic before ESWL, Conservative Treatment of Upper Urinary Tract Trauma to reduces urinary leakage and the risk of strictures, Reconstructive Surgery of the Upper Urinary Tract and identifying the ureter before specific abdominal surgeries. Stent-related symptoms have a high prevalence. They include irritative voiding symptoms including frequency, urgency, dysuria, incomplete emptying; flank and suprapubic pain; incontinence, and hematuria. Objective To evaluate the effectiveness of Double dose versus standard dose of tamsulosin with solifenacin in relieving stent related symptoms. Patients and Methods A Randomized controlled clinical trial was conducted on 64 Egyptian patients from the outpatient clinic and inpatients Urology department of Ain Shams University Hospital for Six months. Results After 2 weeks of medication, the double dose of tamsulosin with solifenacin was more effective for stent-related symptoms than standard dose. There was significant difference in the score between the double dose and the standard dose. Side effects were more frequent among the double dose group with significant difference only in retrograde ejaculation and dry mouth. Conclusion Combination therapy of Tamsulosin with solifenacin is effective in relieving stent related symptoms. In some patients who are still complaining even with this combination we can double the dose of tamsulosin and solifinacin in order to relieve the symptoms even if the temporary and accepted side effects will increase.

FP7.3 - Acute Appendicitis and Lung Metastasis – A rare combination

Abstract Background Lung cancer is the third most common cancer in the UK. Although widespread metastasis is common, metastasis to the appendix is rare. Here we present a case of acute appendicitis secondary to lung metastasis. Case Presentation An 84-year-old man was admitted with a two-day history of right iliac fossa and suprapubic pain. He was known to have previous lung cancer treated with radical radiotherapy. Bloods on admission revealed elevated inflammatory markers with WCC 14.73 x 109/L and CRP 71.1mg/L. A Computed tomography was performed which showed acute appendicitis with perforation. An emergency laparoscopic appendicectomy was performed which showed a mid-appendiceal perforation with a localized abscess cavity. His recovery was uneventful, and the patient was discharged on postoperative day 2. Histological analysis revealed an adenocarcinoma in the appendicular lumen and within the muscle wall extending to the serosal surface. Immunochemistry profile was positive for CK, CK-19, TTF1 and Napsin A favoring a diagnosis of lung adenocarcinoma which was rationalized in the lung MDT. The patient remains under the respiratory physicians for close follow up. Discussion Lung metastasis to the appendix causing acute appendicitis is uncommon, with only twelve cases of appendiceal metastasis reported in the literature, ten of which presented with a perforated appendix. It may be considered as a differential for the cause of perforated acute appendicitis especially in patients with background of lung cancer.

Imperforata Hymen: Secondary Urinary Retention due to Hematocolpos Compression in a 13-Year-Old Woman

Imperforate hymen is a rare congenital anomaly in which the hymen completely covers the vaginal opening, caused by the failure of vaginal plate canalization during the embryonic period. This article reported a 13-year-old girl with a chief complaint of cyclic monthly lower abdominal pain, suprapubic pain, and inability to urinate. She denied prior menstruation. Cystic mass was palpated in the suprapubic area, and the hymen was seen covering the entire vaginal introitus. Hematometra and hematocolpos were found on abdominal ultrasonography and the patient was diagnosed with imperforate hymen. Hymenectomy was performed and she had regular menstruation afterwards. If left untreated, it can lead to morbidities such as infection, endometriosis, subfertility, and kidney failure. It is essential for clinicians to consider imperforate hymen as the differential diagnosis and examine the external genitalia, especially in adolescents with cyclic monthly lower abdominal pain and amenorrhea.

Atypical presentation of herpes simplex virus 2 primary infection: a case report

BackgroundCervicitis, an infectious or noninfectious inflammation of the cervix, encompasses a wide range of clinical conditions, from asymptomatic infections to severe lesions, making its diagnosis difficult. Acute cervicitis may develop into pelvic inflammatory disease. In patients with cervicitis, current guidelines recommend testing for herpes simplex virus when external genital lesions are present. Here, we present the case of a patient with an atypical primary herpes simplex virus 2 infection manifesting as cervicitis without genital lesions.Case presentationA 29-year-old Caucasian woman was hospitalized for pelvic inflammatory disease. The patient complained of severe suprapubic pain, fever, and heavy vaginal discharge. The external genitalia were unremarkable, so empirical antibiotic treatment was initiated. Despite 48 hours of well-administered antibiotic therapy, her complaints persisted. Polymerase chain reaction for possible microbial causes was negative for Chlamydia trachomatis and Neisseria gonorrhoeae. There was no bacterial vaginosis. Repeat gynecological examinations with endovaginal ultrasound revealed an enlarged cervix, and pelvic magnetic resonance imaging supported a diagnosis of cervicitis. At this point, additional screening for other sexually transmitted infections and infectious disease-related etiologies of cervicitis was performed, and the polymerase chain reaction analysis of newly isolated samples was positive for herpes simplex virus 2. No antiviral treatment was initiated given the delay in diagnosing herpes simplex virus 2 infection and the slow but spontaneous abatement of symptoms.ConclusionHerpes simplex virus infection should be considered as a possible cause of cervicitis, even in the absence of typical genital lesions. Early detection of herpes simplex virus allows early treatment, helping to reduce the duration and severity of symptoms and therefore potentially reducing recurrences and improving disease control. These data and data from future cases might spur changes in the guidelines on cervicitis testing and treatment.

Urologic Morbidity in Surgery of Placenta Accreta Spectrum in Universitas Andalas Hospital

Background: Hysterectomy for placenta accreta spectrum disorders is known to be associated with urologic morbidity, including intentional or unintentional cystostomy, ureteral injury, and bladder fistula. Case: A 32year old woman with urine retention post total hysterectomy on indications placenta accreta spectrum Grade 3 type 4 S2 segment- 9 days ago, referred to Universitas Andalas Hospital. The patient complained difficulty to urinate, hematuria and supra pubic pain. Physical examination sign of acute abdomen unclear. A Pelvic abdominal ultrasound was performed, the result were Acites and complex acites, left renal hydronefrosis, cystitis and sludge gallblader. From the laboratory result found anemia, leucocytosis, trombositosis, ureum, creatinine and albumin were in normal limit, hyponatremia, hypokalemia, hypocalsemia. The patient were given antibiotics, blood transfusion and natrium, kalium and calcium correction. Cystoscopy was performed to explore the bladder, the result were found adhesion and ruptured at the posterior wall of the bladder a long 3 cm then proceed with laparotomy to repair the bladder and adhesiolisis. During hospitalization, the patient’s condition was good, hemodynamics was stable with sufficient diuresis. The patient was discharged on day 4 after laparotomy of bladder repair with temporary urine catheter installed. Discussion: This patient diagnose previously is placenta accreta spectrum with percreta graded so had a high risk of urologic morbidity. The bladder ruptured occurred after 9th day of hysterectomy. This can occur because the injury during dissection of the uterine vesicular fold undergoes necrosis and then become opens on the 9th day after hysterectomy. A multidisciplinary team should be made in management of placenta accreta spectrum. A team comprising a consultant maternal fetal medicine with pelvic surgery experienced, a blood bank team, an anesthesiologist, a urologist skilled, an interventional radiologist and an experienced neonatologist is advised. Keywords: urologic complication, placenta accreta, urologic morbidity

Diagnostic Stewardship Opportunities for Emergency Department Evaluation of Children with Suspected Urinary Tract Infection

Background: Among children who start antibiotics for suspected urinary tract infection (UTI) in emergency departments (EDs), 40-60% have negative urine cultures or other results inconsistent with UTI. Practices contributing to excess antibiotic exposure are not well understood. The goal of this study was to understand diagnostic and post-encounter follow-up processes in children who received antibiotics, in order to define targets for intervention. Methods: We identified encounters by children evaluated in two pediatric EDs, over 2 months in the first ED and 9 months in the second ED, to balance different visit volumes. Children 2 months-17 years old were included if they had a urinalysis (UA) and/or urine culture performed, were assigned a primary or secondary diagnosis code for UTI, and initiated antibiotics. Patients were excluded if they received antibiotics prior to the encounter, had prior urologic surgery or device placement, or were immunocompromised or pregnant. Data abstracted by chart review included demographics, documented symptoms, test results, and documented urine culture review and management. Possible UTI symptoms per pediatric criteria included fever, dysuria, urinary frequency, urgency, or hesitancy, suprapubic, abdominal or flank pain, foul smelling urine, or new urinary incontinence. In both EDs, nurses review urine cultures and document changes to treatment plans. Final urine culture results were considered inconsistent with UTI if there was 1) no growth or 2) only mixed growth reported with quantity < 1 00,000 colony forming units/ml. Results: Of 150 eligible children, 146 (97%) had at least one UTI symptom and 146 (97%) had abnormal UA Results: Urine cultures were not performed in 27 (18%) children. Of 123 encounters with urine cultures performed, 71 (58%) had results inconsistent with UTI. Though 67/71 cultures were marked as reviewed, 43/67 (64%) of the patients who could have stopped antibiotics per guideline recommendations did not have documented plans to stop. In those who had documented plans to stop antibiotics, nurses reached 20/23 (87%) caregivers by phone to communicate these recommendations. Conclusion: Many children suspected to have UTI at the time of ED evaluation do not meet criteria for UTI. We found that the most frequent departures from evidence-based practice recommendations were 1) not sending urine cultures, and 2) not stopping antibiotics when culture results did not support the suspected UTI diagnosis. Further investigation should explore barriers and facilitators to these evidence-based practices to develop population- and context-specific diagnostic stewardship strategies.

This pain drives me crazy: Psychiatric symptoms in women with interstitial cystitis/bladder pain syndrome

BACKGROUND Interstitial cystitis/bladder pain syndrome (IC/BPS) is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic, abdominal, and/or pelvic pain. Although the term cystitis suggests an inflammatory or infectious origin, no definite cause has been identified. It occurs in both sexes, but women are twice as much affected. AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS. METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS, we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy: ("interstitial cystitis" OR "bladder pain syndrome") AND ("mood disorder" OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk). RESULTS On September 27, 2023, the PubMed search produced 223 articles, CINAHL 62, and the combined PsycLIT/PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36. Search on ClinicalTrials.gov produced 14 studies, of which none had available data. Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS, i.e. 63 articles spanning from 2000 to October 2023. These studies identified depression and anxiety problems in the IC/BPS population, along with sleep problems and the tendency to catastrophizing. CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS. Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.

A case report of a foreign body in the urethra of an 18-year-old woman

Introduction : The presence of foreign bodies in the genitourinary system can be caused by self insertion, cases of sexual assault, or following trauma. Material and Methods: In this article, we present the details of the case of an eighteen-year-old unmarried woman who referred to the urology clinic due to complaints of suprapubic pain, dysuria and hematuria. Results : In the physical examination, a remarkable finding was the observation of a pencil tip inside the urethra. On ultrasound, a posterior shadow related to a foreign body was seen in the bladder, which extended towards the urethra. The patient underwent surgery and after opening the bladder, a 10 cm long pencil was seen with a stone of about 5 cm around it. Successful removal of this foreign body relieved the patient's symptoms. Conclusions :Overall, this case highlights the importance of early detection and intervention in cases of foreign bodies in the genitourinary tract. With the early detection of foreign bodies in the bladder, it is possible to prevent further damage due to infection or the formation of stones around it.

Synchronous adrenal myelolipoma with renal cell carcinoma: A case report

Synchronous adrenal myelolipoma and Renal Cell Carcinoma (RCC) have been rarely reported in the literature. Cases occurring on the ipsilateral side are even rarer. We report a case of a 65-year-old male who presented with hematuria, lithuria, and suprapubic pain

Could tranexamic acid be a suitable alternative to cryotherapy for symptomatic cervical ectopy? Results from a randomized clinical trial.

Cervical ectropion occurs due to the eversion of the endocervix that exposes glandular cells to the vaginal milieu. The aim of the present study was to evaluate and compare the clinical efficacy of effervescent vaginal tablets of tranexamic acid and cryotherapy in women with symptomatic cervical ectopy. The current randomized clinical trial was conducted on 92 samples of women with cervical erosive ectropion from March 20, 2022 to August 27, 2022. Participants were divided into two groups; the intervention group (n = 46) was treated with a 400 mg effervescent vaginal tablet of tranexamic acid and the control group (n = 46) underwent cryotherapy. All the patients were requested to visit weekly in the first month and then monthly for the next 3 months, and the outcomes encompass improvement of symptoms (leukorrhea, dyspareunia, pelvic pain, post-coital bleeding, and suprapubic pain) and cervical erosive ectropion view were monitored based on repeated examinations. In this study, no statistically significant difference was observed in cure rate of symptoms between study groups (P value > 0.05). Women in both the tranexamic acid and cryotherapy groups reported significant improvements in dyspareunia (34 [75%] vs 31 [67%]), pelvic pain (34 [75%] vs 34 [74%]), post-coital bleeding (37 [81%] vs 31 [67%]), leukorrhea (36 [78%] vs 36 [78%]), suprapubic pain (32 [71%] vs 33 [73%]) disappearance of cervical ectropion tranexamic acid (40 [86%], vs 39 [84%]). Our findings highlighted the equal effect of tranexamic acid and cryotherapy for treating cervical ectropion. Due to the ease of use, availability, and fewer side effects of tranexamic acid, it can be a suitable alternative to cryotherapy. IRCT20220115053719N1. The name of the registry: Iranian Registry of Clinical Trials. URL of registration: https://en.irct.ir/trial/61483.

Amikacin once every other day versus Daily Meropenem for Treatment of Urinary Tract Infection with Escherichia Coli

Background and Aim: Urinary tract infection (UTI) is a common medical challenge, especially in the light of increased antibiotic resistance. This work aimed to compare between amikacin (3 doses, once each other day) with a daily dose of meropenem (once daily for seven days) for the treatment of urinary tract infection caused by Escherichia Coli. 
 Patients and Methods: 70 patients with confirmed UTI infection by E. Coli were included and divided for two groups. The first was treated by amikacin 15mg/kg once every 48 hours for seven days. The second group was treated by meropenem 1 g three times daily for one week. Then, urinary culture and sensitivity was re-performed and tested against the commonest panel of antibiotics. The clinical manifestations were documented before treatment and one week after treatment.
 Results: There was no significant difference between groups regarding patient demographics or manifestations of UTI. 54.3% in amikacin and 65.7% in meropenem groups reported previous UTI. The clinical manifestations of UTI include dysuria, frequent urination, flank pain, abdominal pain, fever and suprapubic pain. The treatment was associated with eradication of E. Coli in 60.0% and 54.3% in Amikacin and meropenem respectively, with no significant differences between groups at the end of the first week and at that time, the most sensitive drugs were nitrofurantoin (34.3%) followed by meropenem (22.9%) and amikacin (18.6%). However, the highest resistance was registered for cefepime and cefotaxime (41.4%) followed by ceftazidime-clavulanic acid (40.0%). Clinical manifestations of UTI were significantly reduced in both groups one week after treatment with no significant differences between groups.
 Conclusion: Amikacin could be considered as is an effective and safe alternative to meropenem for treatment of UTI due to E. Coli.

The Model of Interstitial Cystitis for Evaluating New Molecular Strategies of Interstitial Regeneration in Humans.

Given the recent evidence in the clinical application of regenerative medicine, mostly on integumentary systems, we focused our interests on recent bladder regeneration approaches based on mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), and hyaluronic acid (HA) in the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) in humans. IC/BPS is a heterogeneous chronic disease with not-well-understood etiology, characterized by suprapubic pain related to bladder filling and urothelium dysfunction, in which the impairment of immunological processes seems to play an important role. The histopathological features of IC include ulceration of the mucosa, edema, denuded urothelium, and increased detection of mast cells and other inflammatory cells. A deeper understanding of the molecular mechanism underlying this disease is essential for the selection of the right therapeutic approach. In fact, although various therapeutic strategies exist, no efficient therapy for IC/BPS has been discovered yet. This review gives an overview of the clinical and pathological features of IC/BPS, with a particular focus on the molecular pathways involved and a special interest in the ongoing few investigational therapies in IC/BPS, which use new regenerative medicine approaches, and their synergetic combination. Good knowledge of the molecular aspects related to stem cell-, PRP-, and biomaterial-based treatments, as well as the understanding of the molecular mechanism of this pathology, will allow for the selection of the right and best use of regenerative approaches of structures involving connective tissue and epithelia, as well as in other diseases.

Urinary tract infection in pediatric patients – Recent updates

In children, urinary tract infection (UTI) is a common condition. Prompt identification and treatment are critical for reducing morbidity associated with this illness. Throughout infancy, the symptoms and indications remain nonspecific. During the first 2 years of life, the most prevalent sign of UTI is unexplained fever. Symptoms and indicators of pyelonephritis after the 2nd year of life include fever, chills, rigor, flank discomfort, and costovertebral angle tenderness. Suprapubic pain, dysuria, urinary frequency, urgency, murky urine, malodourous urine, and suprapubic tenderness are examples of the lower tract symptoms and indicators. When UTI is suspected, a urinalysis and urine culture should be conducted. In the treatment of acute uncomplicated UTI, second or third-generation cephalosporin and amoxicillin-clavulanate are currently the medications of choice. Parenteral antibiotic therapy is advised for infants under 2 months of age and any child who seems toxic is hemodynamically unstable, is immunocompromised, is unable to tolerate, or is not responding to oral medication. This study focuses on the most recent updates about UTIs in children and provides a comprehensive overview of the subject.

Ruptured abdominal aortic aneurysm discovered by pocket-sized ultrasound in a low resource setting: a case report

BackgroundAbdominal aortic aneurysm (AAA) is a life-threatening condition characterized by the weakening and dilation of the abdominal aorta. AAA primarily affects men, smokers, and the elderly, with rupture being a fatal complication. While point-of-care ultrasound (POCUS) is valuable in diagnosing AAA, the role of using pocket-sized ultrasound in a low resource setting remains less explored. This case report presents a unique instance of a suspected ruptured AAA diagnosed using pocket-sized ultrasound in an emergency department (ED) situated in a low resource setting where ultrasound machines are absent, and emergency physicians lack proficiency in ultrasound usage.Case presentationA 78-year-old man with a history of hypertension and bladder cancer presented to the ED with suprapubic pain. Initial evaluation showed no concerning findings. However, the next day, he collapsed, became unconscious, and experienced a cardiac arrest. Despite resuscitation efforts, the patient’s condition deteriorated. POCUS revealed an 8-cm dilated abdominal aorta with an intimal flap, indicative of a dissecting AAA and a substrate for AAA rupture. Unfortunately, the patient died despite resuscitation efforts.ConclusionThis case highlights the importance of considering AAA in patients with risk factors and abdominal pain in a low resource setting. POCUS using a pocket-sized ultrasound can aid in early AAA detection, potentially preventing rupture through preemptive vascular intervention. Emergency departments should prioritize ultrasound availability, and emergency physicians should be proficient in its use.

Dilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical case

The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.