Bladder Wall Thickening Research Articles

Emergency Ultrasound of the Gall Bladder: Comparison of a Concentrated Elective Experience vs. Longitudinal Exposure During Residency

It is unknown how an intensive emergency ultrasound (EUS) experience compares with comparable exposure done over the course of residency training. Our objective was to compare the accuracy of EUS of the gall bladder done by physicians after a 2-week EUS elective with similarly numbered examinations done by physicians longitudinally over several years of residency training. This was a secondary analysis of a previously reported prospective study of EUS for biliary disease. The 21(st)-40(th) examinations were compared between those who participated in an EUS elective and those who did not. The gold standard was ultrasound done by the Department of Radiology. Mean time to complete 40 EUS examinations for biliary disease was 14 months for those participating in an EUS elective compared with 29 months for those who did not. One hundred and ninety-one examinations (49%) were done by 19 operators who did not participate in an EUS elective and 202 examinations (51%) were done by 23 operators who completed an EUS elective. There was no statistical difference between the two groups with regard to detecting the presence of gall stones, gall bladder wall thickening, pericholecystic free fluid, ductal dilation, or sludge. Physicians who participated in a 2-week, semi-structured EUS elective demonstrated EUS accuracy for biliary disease that was comparable with those who performed the same number of examinations over a longer period of time.

Desmopressin and oxybutynin in monosymptomatic nocturnal enuresis: a randomized, double‐blind, placebo‐controlled trial and an assessment of predictive factors

To assess the efficacy of desmopressin plus oxybutynin and compare two starting dosages of desmopressin (120 and 240 µg) in a randomized, double-blinded, placebo-controlled trial for children with monosymptomatic nocturnal enuresis (MNE) resistant to desmopressin. The predictive factors of children with MNE responsive to desmopressin and combination therapy were also evaluated. Our sample included 206 patients aged between 6 and 13 (mean age 10.6 ± 2.9 years), 117 males. All patients were required to have MNE. The patients were randomly divided into two groups: the first group was given oral melt 120 µg and the second group 240 µg, for 2 weeks. All patients who had experienced failure of treatment with sublingually administered desmopressin alone were given either desmopressin plus 5 mg oxybutynin or desmopressin plus placebo in a randomized, double-blinded trial for 4 weeks. As predictive factors, bladder volume and wall thickness index, nocturnal polyuria and voiding latency were considered. There was no significant difference between the 120 µg and 240 µg patients in terms of response. The oxybutynin group showed a higher rate of full and partial responses (45% success) compared with the placebo group (17% success), P < 0.01. The responders to combined oxybutynin and desmopressin had significantly lower bladder volume and wall thickness index than the other patients. Our findings highlight that anticholinergic agents may play an important role for a subset of children with enuresis who have a restricted bladder capacity and thickened bladder wall. Ultrasonography-measured bladder variables can provide useful predictive clues for MNE. Predictive factors can help to differentiate treatment subtypes and guide clinical management in primary nocturnal enuresis.

Eosinophilic Cystitis: A Rare Cause of Hematuria in Children

A 7-year-old boy presented with a history of acute onset of hematuria, dysuria, and suprapubic pain. Urine routine and microscopy showed 40–45 red cells/high power field. Urine culture was sterile. Radiological investigations showed a focal mucosal lesion with bladder wall thickening. Biopsy of the lesion revealed an edematous mucosa with florid infiltration by eosinophils into the muscularis propria with focal areas of myonecrosis. He was diagnosed as a case of eosinophilic cystitis. The patient received 6 weeks of tapered prednisone therapy. He was asymptomatic on followup.

Case of Eosinophilic Cystitis Treated with Suplatast Tosilate as Maintenance Therapy

Eosinophilic cystitis is a rare inflammatory lesion of the bladder, characterized by massive eosinophilic infiltration of the bladder wall. Its cause is not known definitely. A 49-year-old man consulted our department with a miction pain, gross hematuria, and frequent micturition. Urinalysis showed combined hematuria and pyuria, but urine culture was sterile. Abnormal findings of laboratory examination included an elevated white blood cell (WBC) count (15,700/μL) and the proportion of eosinophils in the peripheral blood was 12% of the WBCs (normal 0–5%). Cystoscopy revealed a solid mass with severe edematous mucosa. Magnetic resonance imaging (MRI) also indicated marked bladder wall thickening, which was suspected for invasive bladder cancer. Transurethral biopsy of the bladder mass was performed with pathological examination revealing features of eosinophilic cystitis. After administration of a combination of prednisolone and suplatast tosilate, followed by monotherapy with suplatast tosilate, regression of the bladder mass, and normalization of the count of peripheral eosinophils were achieved. Fourteen months after steroid therapy, under treatment with suplatast tosilate, there was no relapse of urinary symptoms and the bladder mass.

Vesico-Appendiceal Fistula Misdiagnosed as Meckel's Diverticulum: A Laparoscopic Approach

A 26-year-old man complained of a vague low abdominal discomfort for the previous 2 months. Radiologic evaluations demonstrated that there was tubular structure connected with the right side wall of the bladder, suggesting Meckel's diverticulum with fistula formation to the bladder as well as a mass-like bladder wall thickening. With an impression of Meckel's diverticulum with fistula with the bladder, laparoscopic surgery was performed to confirm a diagnosis and to manage the Meckel's diverticulum with fistula with the bladder. The distal tip of the appendix was firmly attached to the right side of the bladder. The final diagnosis was corrected by laparoscopy followed by laparoscopic appendectomy and fistula repair. Vesico-appendiceal fistula is an uncommon type of vesico-enteral fistula and a rare complication of unrecognized appendicitis. Additionally, this report showed the significant value of laparoscopy as a diagnostic and therapeutic tool to this entity.

Intestinal Pseudo-obstruction: Initial Manifestation of Systemic Lupus Erythematosus

A 20-year-old man was hospitalized for 2 months after the onset of vomiting, cramping abdominal pain and dysuria. He had been diagnosed as IgA nephropathy 4 months ago. His mother was recently diagnosed as systemic lupus erythematosus (SLE). Physical examination revealed hypoactive bowel sounds and distended abdomen with diffuse tenderness. There was no rash on the face and body. The laboratory investigations showed hemoglobin 11.2 g/dL, leukocyte 10,500/µL, platelet 160,000/µL and albumin 3.2 g/dL. Antinuclear antibody (titer of 1:320 with speckled pattern), anti-Sm and ribonucleotide protein antibodies were positive. The 24 hour urine protein was 1,100 mg/day. Abdominal X-ray demonstrated multiple air-fluid levels of small bowel (Fig. 1). Abdominal CT showed fluid-filled dilatation of small bowel, bilateral hydronephrosis and thickened bladder wall. There was no abnormality on esophagogastroduodenoscopy and colonoscopy. Anorectal manometry showed decreased anal sphincter pressure and intact anaorectal inhibitory reflex. Figure 1 Simple abdominal erect view. Simple abdominal erect film shows extensive dilatation of the small bowel and multiple air-fluid levels. He was treated with empirical prednisolone 30 mg/day for 3 days but abdominal pain was worsened and plain X-ray showed aggravation of ileus. To find out the underlying cause of intestinal pseudo-obstruction (IPO), subtotal colectomy was performed. Grossly there was no mass, ulcer or mechanical obstruction. Histopathology demonstrated diffuse muscular degeneration with little vasculitis suggestive of SLE (Fig. 2). Steroid and azathiopurine were started after surgery and he became well. Figure 2 Microscopic findings of colon. (A) There is diffuse muscular degeneration, fibrosis and multifocal eosinophil infiltration. (B) The vascular lumen is intact and few inflammatory cells are infiltrated around the vessel. (C) Ganglinoic cells are increased ... After IPO in SLE was first described in 1993,1 few cases have been reported thereafter.2-4 As in this case, IPO may appear as the initial presentation of SLE2 and be associated with interstitial cystitis.3-5 The pathophysiology of IPO in SLE is dysmotility of the intestinal muscle, caused by neuropathy, vasculitis or primary myopathy.3-5 As IPO usually respond to high-dose steroid and additional immunosuppressant, early diagnosis and timely initiation of treatment are important to avoid unnecessary surgery.6

A 72-Year-old Male With Left Testicular Pain

i A72-year-old men presented to his primary care physician with a chief complaint of a painful left scrotal mass of 2 weeks’ duration. He had a medical history of noninvasive bladder cancer for which he had completed a 6-week induction course of bacille Calmette-Guerin (BCG) 5 months before his present presentation. During his treatment, other than mild dysuria, he did not recall any scrotal discomfort, fever, or chills. The urine cultures were negative; however, the patient was treated with a 2-week course of ciprofloxacin antibiotics and nonsteroidal anti-inflammatory drugs. During his urologic consultation, the left scrotum was erythrematous, and an indurated mass was palpable at the lower pole of the left testis involving the epididymis, which had not decreased in size. He denied dysuria, hematuria, fevers, chills, nausea, vomiting, weight loss, or changes in bowel movements. He denied any history of urinary tract infections or other genitourinary complaints. Recent routine blood test results, including hemoglobin, hematocrit, liver function tests, -fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase, were within normal limits. His urinalysis revealed microscopic hematuria and was otherwise unremarkable. The urine culture was negative. A testicular ultrasound scan was obtained and revealed a left 3.5 1.5 cm heterogenous, hypoechoic, lobulated mass originating from the epididymal tail, with a mass effect on the lower pole of the testis (Fig. 1). Definitive invasion into the left testis could not be excluded, and the scrotum appeared indurated, with increased echogenicity suggestive of an inflammatory reaction. The right testis and epididymis were normal in appearance. A computed tomography urogram was also obtained and revealed a mildly thickened bladder wall consistent with the known previous bladder cancer and was otherwise unremarkable.

Clinical pathologic analysis of urologic primary primitive neuroectodermal tumor

Objective To explore the clinico-pathological features, immunophenotype, treatment and prognosis of urologic primary primitive neuroectodermal tumor (PNET). Methods The clinical data of 3 patients with urologic PNET were analyzed retrospectively. All patients were male, aged 29, 32 and 75 years respectively. Two of the lesions were located in the kidney, and the third was located in the bladder. The sizes of renal tumors were 7.7 cm×6.2 cm and 12.6 cm×9.4 cm respectively. Imaging examinations revealed a well-defined mass with inhomogeneous echo inside. The size of bladder tumor was 10.0 cm×10.0 cm. CT scan demonstrated irregular thickening of the bladder wall, and the density of the wall was inhomogeneous. In the 2 cases of renal PNET radical surgery was performed, while an emergency palliative surgery to remove a blood clot and biopsy were performed in the bladder PNET case. Results In light microscope, the tumors were characterized by uniform small round or oval cells and nest-like or dense sheet structures surrounded by sparse fibrovascular stroma. Homer-Wright rosettes or pseudorosettes were observed, as well as mitoses. Immunohistochemical study revealed that all cases showed positive staining for CD99, synaptophysin and vimentin. One of the renal tumor cells showed positive for CD56, and the other renal tumor and urocystic tumor cells were focally positive for chromogranin A. Additionally, in 1 of the cases of renal tumor there was a high positive rate of 80% for Ki67 staining while the other case showed less than 5%. All 3 cases were eventually diagnosed as PNET. The first renal tumor case was not treated with radiotherapy and chemotherapy postoperatively, and the patient died of recurrence 14 months after surgery. Both the second renal tumor case and the bladder tumor case underwent chemotherapy postoperatively, and they died 4 and 6 months after surgery respectively. Conclusions The urologic primary PNET is a very rare, highly malignant soft tissue tumor, and the diagnosis must be based on pathologic findings and immunohistochemical phenotypes. The multimodal treatment for urologic primary PNET consists of surgery, chemotherapy and radiotherapy. Key words: Primitive neuroectodermal tumor; Kidney; Urinary bladder; Immunohistochemistry

Polypoid Cystitis Presenting as a Protruding Urethral Mass

Polypoid cystitis, presenting as a protruding urethral mass, is extremely rare. We present a 35-year-old woman with a sudden protruding urethral mass that was found after approximately 1 week of voiding difficulty. A cyst-like lesion around the urethra and thickening of the right posterior bladder wall were observed on a computed tomographic scan. Cystoscopy revealed that the protruding mass originated from the posterior wall of the urinary bladder and was connected by a stalk. Transurethral excision of the bladder mass was carried out, with polypoid cystitis diagnosed histopathologically.

Virtual cystoscopy: the evaluation of bladder lesions with computed tomographic virtual cystoscopy

Our objective was to assess the accuracy of computed tomographic virtual cystoscopy (CTVC) in the detection of urinary bladder lesions. Twenty-five patients were examined using CTVC. Bladder scanned using multislice CT at a slice thickness of 1 mm. The data were transferred to a workstation for interactive navigation using surface rendering. Findings obtained from CTVC were compared with results from conventional cystoscopy and with pathological findings. Thirty-eight lesions were identified. The smallest was 0.2 × 0.3 cm; the largest was 7 × 4.5 cm. Both CTVC and conventional cystoscopy were used. Conventional cystoscopy detected the same number of lesions that were detected by CTVC. On morphological examination, 26 of the lesions were polypoid, 7 were sessile and 5 were bladder wall-thickening. While one of the polypoid lesions was reported as an inverted papilloma, 2 of the 5 lesions that were identified as wall-thickening were malignant and 3 were benign. The sensitivity of using CTVC to identify neoplasias was 100%; the accuracy was 89%. Although the definitive diagnosis of some suspected urinary bladder tumours is only possible with conventional cystoscopy and biopsy, CTVC is a minimally invasive technique which provides beneficial information about urinary bladder lesions.

Endocervicosis of the urinary bladder: a case report and review of the literature

Mullerianosis is an infrequent metaplastic lesion inthe genitourinary tract. Among the various forms of mullerianosis, endocervicosis is the least frequent form. We describe a case of endocervicosis of the urinary bladder, along with a brief of review of literature. Less than 25 cases of this condition have been reported so far. A 67-year-old woman who presented with a 2 week history of lower abdominal discomfort underwent a CT scan, which showed bladder wall thickening and calcification. A cystoscopic biopsy of the lesion was done to exclude malignancy. Histopathology revealed variably sized glands, lined by bland tall columnar mucus secreting cells of the endocervical type. The glands were positive for oestrogen receptor, HBME1, and focally positive for progesterone receptor. These markers are known to be reactive in the cervix but negative in the urothelium. On the basis of these features the lesion was designated as ‘endocervicosis of the urinary bladder’. Although rare, the diagnostic significance of this benign condition lies in its differential and distinction from adenocarcinoma of the urinary bladder.

Presumptive pseudohypoaldosteronism secondary to chronic urinary tract obstruction from sloughed urinary bladder mucosa and urinary tract infection in a cat

To describe a case of presumptive secondary pseudohypoaldosteronism (PHA) in a cat with urinary tract infection and chronic urethral obstruction. The obstruction was believed to have resulted from sloughed urinary bladder mucosa secondary to pressure necrosis. A 5-year-old, 4 kg, castrated male Siamese cat presented for vomiting and stranguria. Medical history included a perineal urethrostomy for urethral obstruction. Physical examination revealed a large, painful, nonexpressible urinary bladder. Point-of-care testing demonstrated electrolyte derangements consistent with a postrenal azotemia and metabolic acidosis. Results of urine culture was positive for bacterial growth. Diagnostic imaging revealed presence of retroperitoneal fluid, marked urinary bladder wall thickening, bilateral hydroureter, mild bilateral pyelectasia, and small nephroliths. The patient was treated for a urinary tract obstruction and infection. In the 3 weeks following initial discharge, the patient was evaluated on multiple occasions for lethargy, intermittent vomiting, inappropriate urination, and progressive polyuria and polydipsia. Although the urinary bladder was easily expressed during repeat examinations, it was persistently distended and subjectively thickened upon palpation. Repeat ultrasound of the urinary tract showed evidence of sloughed tissue in the bladder lumen, likely secondary to chronic urethral obstruction and pressure necrosis. A cystotomy was performed to remove the necrotic tissue, and a revised perineal urethrostomy was done due to a partial urethral stricture. Bladder biopsies were obtained at this time. Postoperatively, the cat was reported by the owners to be urinating normally but continued to be polyuric and polydipsic in the week following discharge. One week after surgery, the cat presented in hypovolemic shock with laboratory findings consistent with a presumptive diagnosis of secondary PHA. PHA has not been reported previously in a cat. This case report suggests that aldosterone resistance should be considered in cats with consistent laboratory findings and a history of documented obstructive uropathy and urinary tract infection.

Encrusting cystitis in a cat secondary to Corynebacterium urealyticum infection

An 18-year-old male neutered domestic shorthair cat was presented for investigation of haematuria and lethargy. The cat had sustained a traumatic T3-L3 lesion 5 years prior resulting in upper motor neuron incontinence. On further investigation the cat was found to be hyperkalaemic, hypothermic and dehydrated. Ultrasonography of the bladder revealed a markedly hypoechoic, thickened bladder wall with an irregular, hyperechoic mucosal layer. The patient responded to symptomatic and supportive care and was discharged. Despite initial improvement, the patient returned 10 days after discharge with recurrence of haematuria and lethargy. Ultrasound-guided aspiration and culture of the material on the mucosal surface of the bladder confirmed diagnosis of UTI caused by Corynebacterium urealyticum. On post-mortem examination, gross and histopathological features were consistent with encrusting cystitis. This is the first case report of encrusting cystitis in a cat. C urealyticum, an uncommon urinary tract pathogen in small animals, should be considered in patients with predisposing conditions.

The Role of Chronic Helicobacter Infection in Hepatobiliary Diseases

Purpose: It is known that Enterohepatic Helicobacter species were identified in the liver tissue, the wall of the bile ducts, and bile. Clinical significance of the presence of bile-resistant Helicobacter spp. in the biliary tract and liver is unclear. We studied a specific pool of patients without any apparent evidence of liver disease, but with chronic gastrointestinal inflammation associated with Helicobacter infection with symptoms that presented for more than 6 months. Methods: A total of 89 patients out of 536 with chronic gastroduodenitis associated with H. Pylori infection were selected. Patients with known liver diseases were excluded from the study. Antibody responses to H. Pylori were evaluated with enzyme-linked immunoassay. Other studies included upper endoscopy with histological study for H. Pylori; abdominal ultrasound; complete biochemical panel; and hepatitis panel. Results: It was found that patients with chronic Helicobacter gastroduodenitis had relatively frequent changes in clinical and laboratory data, specifically increased liver echogenicity, wall thickness of extrahepatic biliary ducts and changes in hepatic transaminases. Most of the patients had a minimal to moderate elevation of transaminases. Majority of the patients (82.5 percent) had elevated levels of anti-Helicobacter IgG and 24.4 percent of the patients had elevated levels of anti-Helicobacter IgM. Total 44 percent of the patients had high anti-Helicobacter IgG levels with concomitant alanine aminotrasferase elevation. However, only a small number of patients with low anti-Helicobacter IgG levels (2.5 percent) had elevation of transminases. Non-specific ultrasound findings included thickening of the gall bladder wall in 89.8 percent of the patients and common bile duct in 33.7 percent. About half of the patients with chronic Helicobacter gastroduodenitis had increased liver echogenicity and elevated specific IgG levels at the same time. Conclusion: Patients with chronic Helicobacter infection that was confirmed by histological and immunological studies were found to have elevation of specific anti-Helicobacter IgG levels that were associated with ALT elevation and increased liver echogenicity as well as sonographic evidence of thickening of the gall bladder wall and extrahepatic bile ducts, indicating possible involvement of hepatobiliary system into the pathological process. There is no clear explanation of these findings, thus, subsequent larger studies are warranted in the future to explore the significance of anti-Helicobacter spp. antibody levels or a role of particular enterohepatic Helicobacter sp. in the pathogenesis of chronic changes in the hepatobiliary system.Table: [238] Overview of nonspecific findings on ultrasound and liver function panel in patients with chronic Helicobacter gastroduodenitis ( n =89)Table: [238] Frequency of alanine aminotransferase elevation in patients with different levels of anti-Helicobacter IgG, IgA, and IgM levels, n/percent

Ketamine-associated lower urinary tract destruction: a new radiological challenge

Ketamine is a short-acting dissociative anaesthetic whose hallucinogenic side effects have led to an increase in its illicit use amongst club and party goers. There is a general misconception amongst users that it is a safe drug with few long term side effects, however ketamine abuse is associated with severe urinary tract dysfunction. Presenting symptoms include urinary frequency, nocturia, dysuria, haematuria and incontinence. We describe the radiological findings found in a series of 23 patients, all with a history of ketamine abuse, who presented with severe lower urinary tract symptoms (LUTS). Imaging techniques used included ultrasonography (US), intravenous urography (IVU), and computed tomography (CT). These examinations were reviewed to identify common imaging findings. All patients with positive imaging findings had also undergone cystoscopy and bladder wall biopsies, which confirmed the diagnosis. The patients in this series have consented to the use of their data in the ongoing research into ketamine-induced bladder pathology. Ultrasound demonstrated small bladder volume and wall thickening. CT revealed marked, generalized bladder wall thickening, mucosal enhancement, and perivesical inflammation. Ureteric wall thickening and enhancement were also observed. In advanced cases ureteric narrowing and strictures were identified using both CT and IVU. Correlation of clinical history, radiological and pathological findings was performed to confirm the diagnosis. This case series illustrates the harmful effects of ketamine on the urinary tract and the associated radiological findings. Delayed diagnosis can result in irreversible renal tract damage requiring surgical intervention. It is important that radiologists are aware of this emerging clinical entity as early diagnosis and treatment are essential for successful management.

ACR Appropriateness Criteria® on Obstructive Voiding Symptoms Secondary to Prostate Disease

Obstructive voiding symptoms are most commonly due to prostatic hyperplasia, but other causes include bladder neck contractures, prostatic carcinomas, neurogenic bladder, and urethral stricture. Symptoms include hesitancy, dribbling, decreased force of stream, and postvoid fullness. Imaging is useful in evaluating the presence and degree of hydronephrosis, estimation of renal function, evaluation of the bladder and prostate, and detection of incidental upper tract malignancies or stones. Various modalities have been used for evaluation of the cause of obstruction. Literature on the indications and usefulness of these radiologic studies for obstructive voiding symptoms in different clinical settings is reviewed.

BK virus-associated hemorrhagic cystitis presenting as mural nodules in the urinary bladder after hematopoietic stem cell transplantation

We report an unusual sonographic presentation of late-onset hemorrhagic cystitis caused by BK virus infection in an 8-year-old who had undergone hematopoietic stem cell transplantation for treatment of relapsed acute lymphoblastic leukemia. Sonography showed the presence of multiple bladder nodules in a background of diffuse bladder wall thickening. The dominant bladder nodule showed increase in size on serial sonograms and was vascularized on Doppler interrogation. Biopsy confirmed BK virus-associated cystitis. Recognition of this sonographic appearance in the appropriate clinical setting might obviate the need for biopsy in these children.

Cistopatía por ketamina

Resumen Objetivo Dar a conocer la patologia urologica que puede producir el consumo cronico de ketamina como droga recreativa. Material y metodos Presentamos el caso de una mujer de 23 anos con un cuadro intenso de sindrome miccional irritativo, que consumia ketamina de forma cronica y diaria. Examinamos los casos descritos en la literatura cientifica, relacionando la cistopatia cronica con el consumo de esta droga. Resultados Patologia que afecta a personas jovenes, tomadores diarios de ketamina, que presentan sintomas del tracto urinario inferior (STUI), con polaquiuria, nicturia, urgencia, incontinencia, dolor hipogastrico y ocasionalmente, hematuria. En tecnicas de imagen, se demuestra un engrosamiento de la pared vesical y una disminucion de la capacidad. No en nuestro caso, pero en series, en la mitad de los casos existe uropatia obstructiva superior uni o bilateral. En la cistoscopia, existen cambios inflamatorios similares a los de la cistitis intersticial e histopatologicamente se demuestran cambios de cistitis cronica inespecifica. Conclusion Se trata de una afeccion desconocida hasta hace poco; se describio por primera vez en 2007. Su incidencia podria ir en aumento y transformarse en un problema de salud. El cese del consumo ha sido la mejor garantia para la mejoria clinica. El tratamiento con toxina botulinica es una opcion que se debe tener en cuenta para el alivio sintomatico.

Ultrasonographic bladder measurements can replace urodynamic study for the diagnosis of non‐monosymptomatic nocturnal enuresis

To compare urodynamic (UD) and ultrasonography (US)-based measurements for the diagnosis and follow-up of patients with non-monosymptomatic primary nocturnal enuresis (NMPNE). The study included 455 enuretic children (282 boys and 173 girls, mean age 9.58 years) with daytime voiding symptoms and with more than one void per night. In healthy children the upper limits for US-measured bladder wall thickness are 3 and 5 mm for a full or empty bladder, respectively. In 419 children the results showed urodynamic signs of an overactive bladder (OAB) and the US-measured bladder wall was thickened. After 6 months of antimuscarinic treatment, we re-assessed the children with US and UD; the relation between UD and US measurements was confirmed. After analysing these data, we considered the use of a new diagnostic assessment for patients with NMPNE. In children with a significant US measurement, i.e. a bladder wall with a thickness of >3 mm (full bladder) and >5 mm (empty bladder), the diagnostic assessment was concluded and therapy was started. We restricted the UD examination exclusively to those patients who either had severe intractable symptoms or did not respond to treatment. This new management was applied to 453 patients with NMPNE. After the first 6 months of therapy all the patients were assessed with a new US study. In all, 343 patients (75.7%) were full-responders, with a normal bladder wall thickness; 82 (18.1%) were partial responders but with no normalization of bladder wall thickness; only 28 (6.2%) were classified as nonresponders with a persistent thickened bladder wall. We favour a more conservative management: the UD study should be limited to the very few patients who either have severe intractable symptoms or do not respond to treatment. In our experience, the US study, which is not invasive, is useful for the diagnosis and follow-up of NMPNE and it is preferable to the UD study, which is invasive and often traumatic for children.

Implantation metastasis of prostate cancer in a suprapubic cystostomy tube needle tract

A 64-year-old male patient with a serum PSA value of 51.91 ng ml(-1) and an magnetic resonance imaging scan suggestive of prostate cancer was admitted with bilateral hydronephrosis and anemia. A suprapubic cystostomy had been inserted 6 months earlier, owing to voiding difficulties. The patient was found to have huge multiple bladder stones and a massively thickened bladder wall. A sectio alta with bladder stone removal and bilateral ureteral stenting was performed. Histopathological examination revealed the growth of prostate cancer cells in the cystostomy tube needle tract.