Trigone Area Research Articles

Cystitis glandularis: MR imaging characteristics in 27 patients.

To explore the diagnostic characteristics of cystitis glandularis (CG) using magnetic resonance imaging (MRI). A retrospective study was conducted on pathologically confirmed patients who underwent bladder MRI examination between January 2019 and November 2023. Image analysis was jointly conducted, with emphasis on lesion location, morphology, size, signal intensity, and pattern of enhancement, by two genitourinary radiologists with 22 and 15 years of experience, respectively. A total of 27 patients with 27 lesions were included (median age 47 years, 24 males). The lesions were mostly located in the bladder trigone area (18/27). The lesions could be categorized as focal thickening (17/27), nodular (8/27), and diffuse thickening of the entire bladder (2/27) in morphological terms. On T2-weighted imaging (T2WI), 15 of 17 focal thickening lesions appeared as a slightly hyperintense thickened inner layer, with a higher signal in the center of the thickened inner layer, resembling a sandwich sign, and 6 of 8 nodular lesions were slightly hyperintense. On T1-weighted imaging (T1WI), 19 patients showed slight hypointensity. The lesions on DWI showed mainly high (5/27) and slightly high signal (21/27), with an average mean apparent diffusion coefficient (mADC) value of 2.171 ± 0.052 × 10-3mm2/s. Among the 23 patients who underwent dynamic contrast-enhanced (DCE) scanning, 18 lesions showed mild enhancement in the arterial phase (average 1.7 times comparing to unenhanced phase), and the degree of enhancement gradually increased in the venous and delayed phases (average 2.2 and 2.3 times compared to the unenhanced phase, respectively), showing a progressive enhancement pattern. On MRI, the majority of CG manifest as focal thickening or nodules in the bladder trigone area, showing slight hyperintensity on T2WI, slight hypointensity on T1WI, and a progressive enhancement pattern, without significant restriction on DWI. Focal thickening lesions may exhibit a special sandwich sign.

Vascular Leiomyoma of oral cavity: A case report in young male patient

Abstract Vascular Leiomyoma of the oral cavity is an uncommon benign soft tissue neoplasia arising from the tunica media of the smooth muscle cells. We reported a rare case of Vascular Leiomyoma involving the retromolar trigone area of a young man. A 24-year-old male presented with a slowly growing mass in the retromolar area, which was associated with pain and difficulty in opening of mouth and eating and drinking. A punch biopsy was taken and sent for histopathological examination which revealed a benign angiomatous lesion. The mass was excised, and the adjoining area was curetted. Histopathological examination confirmed the diagnosis of Vascular Leiomyoma. The immunohistochemistry of cells shows: alpha-smooth muscle (+); vimentin (+), Desmin, actin (+), and S100 (−). Angioleiomyomas are benign lesions, but malignant transformation is a possibility so careful histologic inspection is necessary to distinguish these lesions from their malignant counterpart.

Neuroendocrine Carcinoma of the Urinary Bladder: CT Findings and Radiomics Signature.

Background: We present a case series of Neuroendocrine Carcinoma of the Urinary Bladder (NECB) to analyse their radiologic appearance on CT, find a "Radiomic signature", and review the current literature. Methods: 14 CT cases of NECB were reviewed and compared with a control group of 42 patients with high-grade non-neuroendocrine bladder neoplasm for the following parameters: ring enhancement; implantation site; dimensions; density; margins; central necrosis; calcifications; number of lesions; wall thickness; depth of invasion in the soft tissue; invasion of fat tissue; invasion of adjacent organs; lymph-node involvement; abdominal organ metastasis. To extract radiomic features, volumes of interest of bladder lesions were manually delineated on the portal-venous phase. The radiomic features of the two groups were identified and compared. Results: Statistical differences among NECB and control group were found in the prevalence of male sex (100% vs. 69.0%), hydronephrosis (71.4% vs. 33.3%), mean density of the mass (51.01 ± 15.48 vs. 76.27 ± 22.26 HU); product of the maximum diameters on the axial plane (38.1 ± 59.3 vs. 14.44 ± 12.98 cm2) in the control group, trigonal region involvement (78.57% vs. 19.05%). About the radiomic features, Student's t-test showed significant correlation for the variables: "DependenceNonUniformity" (p: 0.048), "JointAverage" (p: 0.013), "LargeAreaLowGrayLevelEmphasis" (p: 0.014), "Maximum2DDiameterColumn" (p: 0.04), "Maximum 2DDiameterSlice" (p: 0.007), "MeanAbsoluteDeviation" (p: 0.021), "BoundingBoxA" (p: 0.022) and "CenterOfMassB" (p: 0.007). Conclusions: There is a typical pattern (male patient, large mass, trigonal area involvement) of NECB presentation on contrast-enhanced CT. Certain morphological characteristics and encouraging results about Radiomic features can help define the diagnosis.

Placenta accreta spectrum with severe morbidity: fibrosis associated with cervical-trigonal invasion

Objective Describe the clinical-surgical results of patients with PAS in the low-posterior cervical-trigonal space associated with fibrosis (PAS type 4) compared with PAS types in other locations (Types 1, upper bladder, 2 in upper parametrium) and in particular with PAS type 3, corresponding to dissectible cervical-trigonal invasion. The clinical-surgical results of using a standard hysterectomy were analyzed with a modified subtotal hysterectomy (MSTH) in patients with PAS type 4. Material and methods A descriptive, retrospective, multicenter study included 337 patients of PAS; thirty-two corresponding to PAS type 4, from three PAS reference hospitals, CEMIC, Buenos Aires, Argentina, Fundación Valle de Lili, Cali, Colombia, and Dr. Soetomo General Hospital, Surabaya, Indonesia, between January 2015 and December 2020. PAS was diagnosed by abdominal and transvaginal ultrasound and topographically characterized by ultrafast T2 weighted MRI. In persistent macroscopic hematuria after MSTH, the surgeon performs an intentional cystotomy and uses a square compression suture to achieve the hemostasis inside the bladder wall. According to a PAS topographical classification, the patients with low-vesical cervical involvement compared with PAS located in relation with the upper blader (type1), upper parametrium (type 2 upper), and also with PAS situated in the lower vesical-trigon space (type 3). PAS 3 and 4 are located in identical area, but in type 3, group A, the vesicouterine space was dissectible, and in type 4, group B, significant fibrosis made surgical dissection extremely challenging. Furthermore, group B was divided into patients treated with total hysterectomy (HT) and those treated with a modified subtotal hysterectomy (MSTH). The surgical requirements to perform an MSHT included the availability of proximal vascular control at the aortic level (internal manual aortic compression, aortic endovascular balloon, aortic loop, or aortic cross-clamping). Then surgeon performed an upper segmental hysterotomy, avoiding the abnormal placenta invasion area; after that, the fetus was delivered, and the umbilical cord was ligated. After uterine exteriorization, the surgeon applies a continuous circular suture with number 2 polyglactin 910, taking some portions of the myometrium -to avoid unintentional slipping- around the lower uterine segment and a 3–4 cm proximal to the abnormal adhesion of the placenta. After tightening hard the circular suture, the uterine segment was circumferentially cut, three centimeters proximal to the circular hemostatic sutures. Next, the surgery follows the upper steps of conventional hysterectomy without changes. Additionally, the histological presence of fibrosis was examined in all samples. Results Modified subtotal hysterectomy in patients with PAS type 4 (cervical-trigonal fibrosis) resulted in a significant clínico-surgical improvement over total hysterectomy. The median operative time and intraoperative bleeding were 140 min (IQR 90–-240) and 1895 mL (IQR 1300–2500) in patients undergoing modified subtotal hysterectomy, and 260 min (IQR 210–287) and 2900 mL (IQR 2150–5500) in patients treated with total hysterectomy, respectively. The complication rate was 20% for MSHT and 82.3% for patients with a total hysterectomy. Conclusions PAS in the cervical trigonal area associated with fibrosis implies a greater risk of complications due to uncontrollable bleeding and organ damage. MSTH is associated with lower morbidity and difficulties in PAS type 4. Prenatal or intrasurgical diagnosis is essential to plan surgical alternatives to improve the results.

MP22-03 CLINICAL SIGNIFICANCE OF CYSTITIS GLANDULARIS IN PATIENTS WITHOUT A PREVIOUS HISTORY OF URINARY MALIGNANCY

You have accessJournal of UrologyCME1 Apr 2023MP22-03 CLINICAL SIGNIFICANCE OF CYSTITIS GLANDULARIS IN PATIENTS WITHOUT A PREVIOUS HISTORY OF URINARY MALIGNANCY Jinhyung Jeon, Jee Soo Ha, Su-Jin Shin, Hyunho Han, Joo Yong Lee, Kwang Suk Lee, Kyo Chul Koo, Daeho Kim, June Seok Kim, Young Deuk Choi, and Kang Su Cho Jinhyung JeonJinhyung Jeon More articles by this author , Jee Soo HaJee Soo Ha More articles by this author , Su-Jin ShinSu-Jin Shin More articles by this author , Hyunho HanHyunho Han More articles by this author , Joo Yong LeeJoo Yong Lee More articles by this author , Kwang Suk LeeKwang Suk Lee More articles by this author , Kyo Chul KooKyo Chul Koo More articles by this author , Daeho KimDaeho Kim More articles by this author , June Seok KimJune Seok Kim More articles by this author , Young Deuk ChoiYoung Deuk Choi More articles by this author , and Kang Su ChoKang Su Cho More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although cystitis glandularis (CG) is no longer considered as a premalignant condition, its clinical significance is still unclear. We aimed to understand clinical significance of CG in large contemporary series. METHODS: We retrospectively reviewed a total of 169 patients diagnosed with CG in two tertiary hospitals from 2005 to 2021. Fifty-nine patients with previous or concurrent history of urinary tract malignancy were excluded. Medical records including demographics, endoscopic and imaging studies, and their management were reviewed. Finally, 110 patients were enrolled in the analysis, and their mean follow-up was 3.3 years. RESULTS: The mean age was 52.0 years, and the male / female ratio was 2.4:1. Presenting symptoms were gross hematuria, voiding problems and flank pain in 43.6%, 27.3% and 10.9%, respectively, and the others were asymptomatic. In cystoscopic findings, trigonal area (n = 87, 79.1%) was the most common site of CG. Thirty-six patients (32.7%) showed extensive lesions, including the bladder neck circumferentially, and the others revealed focal lesions. Patients with extensive lesions were predominantly male (97.2%) and relatively younger than those with focal lesions (40.4 years vs. 57.1 years). Imaging studies revealed urinary stones in 21 patients (22.3%) and hydronephrosis in 16 patients (17.0%). Hydronephrosis was caused by the same CGin 6 patients (6.4%) and by other causes such as urinary stones and ureteral strictures in 10 patients. CG-induced hydronephrosis was successfully managed by transurethral resection in 4 patients, but renal function was deteriorated with aggravated hydronephrosis in 1 patient and ureteroneocystostomy was performed in 1 patient. Subsequent urinary malignancy was developed in 4 patients, all of their histology was urothelial carcinoma, which was diagnosed 6, 12, 17, and 36 months later. No adenocarcinoma was found. CONCLUSIONS: This large contemporary series also argues that CG is not a premalignant lesion for adenocarcinoma. However, subsequent urothelial carcinoma was found in some patients, which may be missed on initial examination or occur later. This suggests that thorough initial work-up and careful follow-up are mandatory for CG despite its benign nature. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e296 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jinhyung Jeon More articles by this author Jee Soo Ha More articles by this author Su-Jin Shin More articles by this author Hyunho Han More articles by this author Joo Yong Lee More articles by this author Kwang Suk Lee More articles by this author Kyo Chul Koo More articles by this author Daeho Kim More articles by this author June Seok Kim More articles by this author Young Deuk Choi More articles by this author Kang Su Cho More articles by this author Expand All Advertisement PDF downloadLoading ...

A bird's-eye view of pathologist over diagnostic confusion of oral cavity lesions.

Oral cavity can be host to multitude of neoplastic, premalignant or non neoplastic pathological lesions. Diagnosis of lesions of oral cavity is always of interest to clinician and pathologist and rely on clinical appearance of lesions. There can be variation in diagnosis of clinical lesion with histopathology. Many oral carcinomas arise within the sites that previously had premalignant lesion. Incidence of oral cancers in population has increased among younger generations related to habits and lifestyle. These lesions during clinical presentation are misleading and create diagnostic dilemma owing to age, sex and distribution of lesions. Understanding distribution of oral mucosal lesions helps to diagnose lesions of oral cavity. Purpose of this study is to observe the variation in clinical diagnosis with histopathological diagnosis in patients with inflammatory, premalignant, benign and malignant lesions of oral cavity and oropharynx and also clinical distribution of lesions of oral cavity and oropharynx lesions by histopathology. Out of total 105 lesions, ulcer in oral cavity seen in 58 (55.23%) of patients, followed by swelling or feeling of lump in oral cavity in 36 (34.29%) of patients and foreign body sensation in 23 (21.90%) of patients with tongue as most frequent site for most of lesions of oral cavity accounting in 33 (31.43%) of cases, and less frequently lesions were seen in retro molar trigone area in 2 (1.90%) patients. Histopathological diagnosis of premalignant, non neoplastic and inflammatory lesions was made in 24 (22.85%) cases, benign tumours were diagnosed in 14 (13.33%) cases and rest of 67 (63.81%) lesions were malignant. Mucocoel were seen in five (4.76%) cases, radicular cyst was seen in one (0.95%) case of female patient and four cases of Leukoplakia with one case showing mild dysplasia. Among benign tumours 11 (10.47%) patients presented with gingivitis turned out to be squamous papillomas were seen in five (4.76%) cases, fibroma was diagnosed in four (3.80%) cases, pyogenic granuloma was diagnosed in four (3.80%) cases most commonly seen over gingiva and myoepithelioma of minor salivary gland was observed in one (0.95%) case over soft palate. Out of 67 cases of malignant lesions squamous cell carcinomas were seen in 59 (88.05%) cases followed by verrucous carcinoma in 3 (4.47%) cases, 2 (2.99%) cases were basaloid squamous cell carcinomas, mucoepidermoid carcinoma was seen in 2 (2.99%) cases and 1 (1.49%) case of adenoid cystic carcinoma was seen. Majority of squamous cell carcinomas cases in study were well differentiated in 49 (73.13%) cases followed by moderately differentiated in 16 (23.88%) cases and poorly differentiated in 2 (2.99%) cases. Malignant transformation of tonsil tissue post operatively was observed in 1 (0.95%) patients on histopathology. One (2.5%) case of myoepithelioma was seen in 60 years male over soft palate. Of all oral biopsies reported in study, increasing trend of malignancies in lower age groups of population making it an emerging threat to community and highlighting need to take effective measures to increase public awareness about risk factors and consequences of this condition. Screening programmes targeted to population over 25 years are recommended to overcome this.

A Microrobot With an Attached Microforce Sensor for Transurethral Access to the Bladder Interior Wall

AbstractWe present the conceptual design and limited functionality prototype and characterization of a system for application in transurethral palpation of any targeted area of the bladder interior wall tissue consisting of a robotic manipulator and a microforce sensor attached at its tip all less than 3.5 mm in diameter. A hyper-redundant ten-joint six degrees-of-freedom (6DOF) manipulator (5DOF rigid and five-joint continuum segments) is presented along with the forward and inverse kinematics analyses based on a Jacobian formulation to prevent configuration singularities. Simulated motion studies demonstrate the ability of the proposed manipulator to attain a desired pose (normal to the tissue) with any area in the bladder including the difficult to reach trigone area. A strain gauge-based microforce sensor is designed using finite element analysis (safety factor > 3), prototyped using additive manufacturing, and characterized. The characterized sensor was used to acquire in vivo measurements to evaluate human palm tissue viscoelastic properties. A single module of the continuum segment is designed and prototyped using additive manufacturing, and used to characterize its tension-bend angle behavior. Finite element analysis is used to improve structurally weak regions of the vertebra. A three-joint four-vertebrae prototype was successfully actuated to reach a bend state using tendons. The developed robot and sensor prototypes demonstrate capabilities of the proposed concept which could be a possible solution to quantitatively evaluate localized biomechanical properties of the bladder tissue to improve treatment and provide better patient care.

Effect of Intratrigonal Botulinum Toxin in Patients with Bladder Pain Syndrome/Interstitial Cystitis: A Long-Term, Single-Center Study in Real-Life Conditions.

The high percentage of treatment failures seen in patients with bladder pain syndrome/interstitial cystitis (BPS/IC) managed conservatively frequently demands invasive treatment options. We aimed to evaluate the long-term efficacy and adverse events of intratrigonal botulinum toxin injection in such circumstances, as well as to determine possible predictors of response to toxin treatment. A retrospective cohort study included 47 female BPS/IC patients treated with onabotulinum toxin A (OnabotA) in a tertiary hospital between the years 2009 and 2022. All patients received 100 U of OnabotA in ten injections limited to the trigonal area. Patients were divided into three groups based on their treatment response as responders, non-responders and lost to follow-up due to non-medical reasons. The clinical and surgical records of the individuals were retrieved, including the 10-point visual analogue scale (VAS), the number of treatments, the time between injections, and the age at the first injection. A total of 25 patients (>50% of the cohort) were long-term responders, but none of the evaluated parameters was a predictor for this circumstance: age, pain intensity, or duration of improvement following the injection. The time between injections was stable (around 1 year). No severe adverse events were registered. The intratrigonal injection of botulinum toxin in patients with BPS/IC was an effective and safe long-term treatment for patients' refractory to conservative forms of treatment. Age, basal pain intensity, and time to injection request did not predict long-term response to OnaBotA.

Entrapped temporal horn syndrome: a retrospective analysis of 5 case series

Introduction: Entrapped temporal horn (ETH) syndrome is a rare form of localized noncommunicating hydrocephalus, which is often associated with the treatment of lesions around the trigone area (atrium) of the lateral ventricles. So far, only a few cases have been reported in the literature. Thus, we present our experience with the causes and management of patients with ETH syndrome at our institution. Materials and method: We retrospectively analyzed clinical data of 5 patients with ETH syndrome treated at our facility from July 2018 to August 2021. Patients’ data such as age, sex, initial disease, clinical presentation, radiologic diagnosis, treatment, and outcomes were documented and analyzed. Results: Our patients comprise of 3 females and 2 males. Their ages ranged from 42 to 85 years, with a mean age of 62 years. Postoperative adhesions caused ETH in 3 patients while meningioma and intracranial infection cause the ETH in 2 patients, respectively. One patient was treated via craniotomy, 3 patients were treated via shunting while 1 patient was treated conservatively. The ETH resolved in 4 patients, while no resolution was attained in 1 patient. Conclusion: Definitive treatments via craniotomy or shunting were capable of resolving the ETHs, while conservative treatment did not result in spontaneous resolution. Unresected meningioma around the trigone of the lateral ventricle is capable of causing the ETH, contrary to the notion that, infection or postoperative adhesions are the key causes of ETH. Thus, neurosurgeons ought to be on a lookout for ETH when treating lesions around the trigone area of the lateral ventricles.

Step-wise Treatment of Bladder Pain Syndrome: Case Report

Bladder pain syndrome/interstitial cystitis is a condition characterized by chronic pelvic and bladder pain (lasting longer than 6 months) accompanied by urinary symptoms (urinary frequency, urgency and nocturia). It can have a highly negative effect on the quality of life. The treatment of this disease is impeded by lack of understanding of its etiology. Therefore, treatment recommendations and information about their efficacy are scarce. The American Urological Association recommends a step-wise therapeutic approach starting from mere patients’ lifestyle modification to pharmacological therapy or to even more complex methods, such as intravesical botulinum toxin-A injections. We present here a case of a 60-year old woman, who presented in 2020 with tiresome symptoms characteristic to bladder pain syndrome lasting for two years. Previous treatments with antibiotics, anti-inflammatory, analgesic and anticholinergic medications were unsuccessful; urine culture was negative. During the cystoscopy in our center small bladder capacity and minute glomerulations were observed. Urodynamic tests (cystometry) were performed showing hypersensitive bladder with small capacity. Bladder hydrodistention procedure was performed twice; however the positive effects only lasted up to one month each time. Therefore, it was decided to perform an intravesical botulinum toxin-A injection into bladder trigonal area after which the patient experienced a significant relief in bladder pain, reduced urinary frequency during the day and night and improved quality of life.

Extraocular muscle expansion after deep lateral orbital wall decompression: influence on proptosis reduction and its predictive factors.

To examine the relationship between extraocular muscle expansion and proptosis reduction (Δproptosis) in patients with thyroid eye disease who underwent deep lateral orbital wall decompression and to analyze the factors that contribute to extraocular muscle expansion. This retrospective, observational study included 133 sides from 77 patients with thyroid eye disease. The cross-sectional areas of the greater wing of the sphenoid bone (trigone), extraocular muscles, and superior ophthalmic vein were measured on computed tomographic images. Variables influencing Δproptosis were analyzed using multivariate linear regression analyses with stepwise variable selection. Predictive factors for the rate of postoperative increase in the cross-sectional extraocular muscle areas (Δextraocular muscle) were analyzed using the same statistical method. The amount of orbital fat removed (P < 0.001) and rate of Δlateral rectus muscle (P < 0.001) were positively and negatively correlated with Δproptosis, respectively (r = 0.425; adjusted r2 = 0.168; P < 0.001). The cross-sectional trigone area (P < 0.001) was positively correlated with the rate of Δlateral rectus muscle, whereas the preoperative cross-sectional lateral rectus muscle area (P < 0.001) and amount of orbital fat removed (P = 0.036) were negatively correlated with the rate of Δlateral rectus muscle (r = 0.551; adjusted r2 = 0.288; P < 0.001). Lateral rectus muscle expansion was negatively correlated with proptosis reduction and proved to be predictable before surgery. The results of this study will help predict proptosis reduction after deep lateral orbital wall decompression and to preoperatively plan additional orbital bony and fat decompression.

Poster Presentation

Poster Presentation

English

BACKGROUND A Zimskind et al. in 1967 first described ureteral stenting, and it has become an integral part of the urological procedure since then. There are various problems associated with the procedure of DJ (Double J) stenting. Post stenting complications such as blockage of the stent (25 %), stent migration, haematuria, flank pain, stent irritating trigonal area leading to LUTS (Lower Urinary Tract Symptoms) (78 %), stent pass off, infection, formation of biofilms (11 %), and reflux. The exact mechanism causing stent-related symptoms is not known but the proposed mechanism for it is that firstly intravesical portion of the stent acts as a foreign body which irritates bladder mucosa especially at the trigonal area of the bladder and neck of the bladder. It becomes important to study the methods of measuring required length of stent; there are direct and indirect methods to do so. We wanted to study the direct method of measuring required stent length along with its effect on symptomology. METHODS A total of 43 patients who underwent DJ stenting for various reasons were included in the study. The ureteral length was measured using a ruled 5-Fr ureteral catheter under C-arm guidance. With the help of air pyelogram, the exact length of the ureter was noted endoscopically. A stent of the nearest length to the measured ureteric length was inserted. Stent-related morbidity was assessed with the help of post-operative stent related symptomatology. Length of the stent in the bladder is a major determinant of symptoms. RESULTS Of the 43 patients, 23 (53.5 %) patients underwent unilateral and 20 (46.5 %) patients underwent bilateral DJ stenting. The commonest indication for surgery was urolithiasis. 4 (9.3 %) patients had postoperative stent-related symptoms. CONCLUSIONS Choosing a double J stent by direct measurement of ureteric length can be a very useful, yet simple method to prevent post-stenting morbidity and needs further evaluation. KEYWORDS DJ Stent, Ureteric Length, Stent Length, Stent Related Symptoms

Transurethral resection of a bladder trigone leiomyoma: a rare case report

BackgroundBladder leiomyomas are rare and benign tumors of the bladder. They account for 0.43% of all bladder tumors, and only 250 cases have been reported in English literature. Based on the size and localization of the lesion, their symptoms vary considerably. Women seem to be more affected, and obstructive symptoms predominate. Surgical treatment is almost always highly effective, leaving a low recurrence rate.Case presentationWe present a clinical case of a 52-year old man with macroscopic hematuria and obstructive lower urinary tract symptoms due to a large bladder trigone leiomyoma. CT and MRI showed a well-defined large bladder leiomyoma and cystoscopy established the initial findings. The patient underwent successful transurethral resection of the lesion, and pathology findings confirmed the diagnosis.ConclusionsThis case report demonstrates that transurethral resection of a large bladder trigone leiomyoma is a feasible and successful procedure. Long term follow-up proves that there is neither scarring distortion of the bladder trigone area nor damage in the ureteral orifices, even though there was a thorough removal of the trigone wall.

Glandular and Cystic Bladder Cystitis: Case Report and Review of the Literature

Glandular-cystic bladder cystitis is a rare, benign non-tumor condition, preferentially located on the area of the bladder trigone and can simulate a malignant tumor. It is a benign reactive metaplasia of the bladder submucosa, characterized by hyperplasia of the islets of Von Brunn and cystic. It is classified among reactive epithelial anomalies of the urothelium, such as islet hyperplasia of Von Brünn, cystitis, glandular cystitis, nephrogenic metaplasia and epidermoid metaplasia. It presents a clinical diagnostic challenge having the expression of a simple recurrent cystitis and misleading the radiological diagnosis evoking a malignant tumor of the bladder. Its certainty diagnosis is histological. We report the case of a 38-year-old young man who consulted for recurrent cystitis. The CT scan showed a vegetative tissue structure of the middle and left medial vesical floor, sawtooth 3 cm long axis suspecting a tumor of the bladder. The patient underwent transurethral resection of the bladder lesion. The histological and immunohistochemical examination concluded with glandular and cystic cystitis (minor form). In the light of this observation, we will discuss the diagnostic difficulties, the pathophysiological mechanisms, the radiological aspects, the anatomopathological, therapeutic features and the prognosis of this rare condition. The literature regarding this entity has been reviewed and the differential diagnosis was discussed.

Cesarean bladder injury - obstetrician's nightmare.

Urinary bladder is an adjacent viscus susceptible for intraoperative injury during cesarean section (CS). Prolonged labor, scarred uterus, intraabdominal adhesion, emergency CS, advanced labor, cesarean hysterectomy etc., are the predisposing factors for bladder injury during CS. While operating on such conditions, one should be meticulous to explore the possibility of bladder injury. Family physician practicing community obstetrics should be aware of this and know how to tackle this. Usually the dome of the bladder is injured and the trigonal area remains away from the injury field by 6–10 cm. Bladder rent is repaired in two layers either by continuous simple or interrupted suture with 3-0 & 2-0 polyglycolic acid suture. Suprapubic cystostomy and transurethral catheter are kept for 10–14 days. While postoperative adhesion, CS during full dilatation of cervix, abnormal anatomy etc., may not proceed for negligence, bladder injury in normal patients and unrecognized intraoperative bladder injury may attract penalty from the consumer court.

Comparison of Triamcinolone Versus Platelet Rich Plasma Injection for Improving Trismus in Oral Submucous Fibrosis

Objective: To compare the effect of Triamcinolone versus Platelet Rich Plasma (PRP) injection intraorally for improving trismus in Oral Submucous Fibrosis (OSMF). Study Design and setting: Randomized double-blind comparative study, conducted at ENT department of PNS Shifa Hospital, Karachi from 1st June 2015 to 30th June 2016. Methodology: Eighty patients with trismus due to oral submucous fibrosis were divided randomly into two groups, ‘A’ and ‘B’ of 40 patients each. In Group A, Inj. Triamcinolone 40mg (1 ml) was injected into the sub-mucosal plane in the retro-molar trigone area and into the fibrous bands along the soft palate on multiple sites, weekly for 6 weeks. In group B Inj. PRP 1ml weekly was administered for 6 weeks along the same site. Vernier calipers were used to precisely measure the Maximum Interincisal Distance (MIID) in cms before and after the treatment. Result: There was a male preponderance in the study group with a male to female ratio of 5.1:1. In group ‘A’ mean pretreatment MIID was 2.3±0.7 cms, while in group ‘B’, it was 2.2± 0.5 cms. After completion of 6 weeks treatment the mean MIID improved in group ‘A’ to 3.08 ± 0.8cms, and in group ‘B’ to 3.22± 0.5cms. The mean improvement in MIID in group ‘A’ was 0.783± 0.25cms compared to 1.01± 0.05 cms in group ‘B’ (p &lt; 0.05). Conclusion: Intraoral injection of PRP is more effective than Triamcinolone in improving trismus due to OSMF

Initial Evaluation of a Novel Modulated Radiofrequency-based Bladder Denervation Device

ObjectiveTo determine if targeted and modulated radiofrequency ablation (RFA) of the urinary bladder using our novel ablation device (Denerblate) reduces bladder nerve density, potentially leading to a novel strategy for the management of overactive bladder. MethodsFifteen pigs were divided into 4 groups: control (n = 3), 1-week (n = 4), 4-week (n = 4) and 12-week (n = 4) survival times. Denerblate was deployed on the trigone area of the bladder. Three 240-second cycles of modulated RFA were applied with 30 seconds between cycles. At the end of each survival term, urinary bladders were harvested for histopathologic evaluation. Nerve count and density were manually calculated. ResultsAll procedures were successfully completed, and all animals survived to the desired time points. Mean nerve density (nerves/mm2) was highest in the control and 1-week survival group compared to the 4-week and 12-week groups, both of which demonstrated significant diminishment. Nerve density in the bladder neck at control, 1 week, 4 weeks, and 12 weeks were 1.8, 1.35, 0.87, and 0.12, respectively (P <.001). Nerve density in the bladder trigone area at control, 1 week, 4 weeks, and 12 weeks were 1.5, 0.98, 0.65, and 0.112, respectively (P <.001). Epithelial heat injury was observed in 14.3% at 1 week, 10.7% at 4 weeks, but completely resolved by 12 weeks. ConclusionIn the porcine model, modulated RFA delivered by our novel device reduced nerve density in the bladder neck and trigone by 88.6% and 88.9% at 12 weeks without evidence of lasting epithelial injury.

Clinical features, radiological findings, and treatment outcomes of high-grade lateral ventricular meningiomas: a report of 26 cases.

High-grade meningiomas in ventricles are rare, where most published series only include a few patients. A retrospective analysis was performed on the clinical features, radiological findings, and treatment outcomes of 26 patients with high-grade meningiomas in lateral ventricles who were surgically treated in our hospital between July 2008 and July 2016. A female predilection (female/male = 1.4:1) was observed with a mean age of 42.4years. Headache and/or vomiting (65.3%) were the most common initial symptom, and with symptom duration time ranging between 7days and 5years (mean 8.5months). The lateral ventricle trigone area was the most common site (80.7%). Twenty-two patients (84.6%) obtained gross total resection. The 2007 WHO classification was used to classify 22 (84.6%) meningiomas as grade II and the remaining four tumors were graded III. These tumors accounted for a recurrence rate of 38.5% (10 of 26 patients) and a mortality rate of 11.5% (3 deaths) during the follow-up periods. The recurrence rate after the gross total resection was 27.3% (6 of 22 patients). Radiotherapy was administered as an adjuvant treatment in 12 patients (46.2%) after surgery. There were 4 recurrences out of the 12 patients who received radiotherapy and 6 of the 14 patients relapsed without radiotherapy (p = 0.58). The subtotal resection was considered a risk factor for recurrence. The postoperative radiotherapy seemed to have little significance for the high-grade meningiomas in the lateral ventricles. Long-term follow-up is required, regardless of the resection grade, and reoperation is feasible for patients with recurrence.

Clear cell ependymoma with an atypical localisation mimicking intracranial glial tumour: A case report

Introduction Ependymomas are tumours of the central nervous system, originating from the ependymal cells which line the ventricles and the central canal of the spinal cord. Less than one-third of all ependymomas are located supratentorially, most of the time in close proximity to the ventricle walls around the trigone area. Case 34 year-old patient came into the outpatient clinic with headache and seizure. After radiological examination, she was operated on for an extra axial lesion located next to the left frontal gyrus. Pathological examination revealed a clear-cell ependymoma, WHO grade II, after which follow-up without any additional therapy was decided since the patient was young and total resection had been achieved. Conclusion Because of low incidence, radiological diagnosis is difficult. Even if total resection has been achieved, long term follow-up should be planned because of high rates of recurrence.