Trigone Area Research Articles

Lateral Intraventricular Anaplastic Meningioma: A Series of 5 Patients at a Single Institution and Literature Review

Lateral intraventricular anaplastic meningiomas (LIAMs) are rare lesions. The aim of this study is to clarify clinical and radiologic characteristics and the optimal treatment strategies of LIAMs with long-term follow-up. From September 2008 to September 2017, 5 patients with LIAM were enrolled in our study. The clinical profiles, radiologic features, treatment strategies, and outcomes were retrospectively analyzed. Five patients (all female; mean age, 48.8 years; range, 33-61 years) were included in this study. The most frequent symptoms were those related to increased intracranial pressure. Mean duration of symptoms was 6.7 months (range, 2 weeks-2 years). The average tumor size was 4.98 cm at the maximal diameter (range, 3.0-6.2 cm). All were confirmed with a diagnosis of anaplastic meningioma. Gross total resection was achieved in all 5 patients. All patients experienced improvement of symptoms. Recurrence and progression were identified in only 2 patients. At the last follow-up, the mean recurrence-free survival was 13 months (range, 7-21 months) and the mean overall survival was 16.25 months (range, 8-21 months). One patient was lost to follow-up. Female and right trigone area predominance were found in our case series. Shorter duration of symptoms, irregular tumor shape, peritumoral edema, and heterogeneous enhancement may indicate an aggressive feature. Maximal safe resection followed by radiation therapy may be the best strategy for patients with LIAM. Long-term clinical follow-up and serial imaging are recommended.

Incorporating a continuous suction system as a preventive measure against fistula-related complications in head and neck reconstructive surgery.

BackgroundAlthough previous studies have focused on determining prognostic and causative variables associated with fistula-related complications after head and neck reconstructive surgery, only a few studies have addressed preventive measures. Noting that pooled saliva complicates wound healing and precipitates fistula-related complications, we devised a continuous suction system to remove saliva during early postoperative recovery.MethodsA continuous suction system was implemented in 20 patients after head and neck reconstructive surgery between January 2012 and October 2017. This group was compared to a control group of 16 patients at the same institution. The system was placed orally when the lesion was on the anterior side of the retromolar trigone area, and when glossectomy or resection of the mouth floor was performed. When the orohypopharynx and/or larynx were eradicated, the irrigation system was placed in the pharyngeal area.ResultsThe mean follow-up period was 9.2±2.4 months. The Hemovac system was applied for an average of 7.5 days. On average, 6.5 days were needed for the net drain output to fall below 10 mL. Complications were analyzed according to their causes and rates. A fistula occurred in two cases in the suction group. Compared to the control group, a significant difference was noted in the surgical site infection rate (P<0.031).ConclusionsClinical observations showed reduced saliva pooling and a reduction in the infection rate. This resulted in improved wound healing through the application of a continuous suction system.

ANTENATALLY DIAGNOSED UPPER MOIETY HYDRONEPHROSIS IN A CHILD WITH ECTOPIC URETER: A CASE REPORT

An ectopic ureter is any ureter, single or duplex, that does not enter the trigonal area of the bladder. In a duplex system, the ectopic ureter is inevitably the upper pole ureter. In males, the ectopic ureter always enters the urogenital system above the external sphincter. The majority of ectopic ureters are detected through prenatal ultrasound imaging, even if the specific diagnosis is not made until after birth. Radionuclide renal imaging remains the gold standard for renal functional assessment, and this is usually best provided by dimercaptosuccinic acid imaging. The goals of therapy are the preservation of renal function; elimination of infection, obstruction, and reflux; and maintenance of urinary continence. We report a case of a 6-month-old male child presenting with urinary tract infection. The child was diagnosed to have had a cystic dilatation of the right upper moiety on antenatal ultrasonography imaging.

Partial cystectomy and bilateral ureteroneocystostomy for resection of invasive transitional cell carcinoma involving the trigone area of the bladder in a dog - case report

ABSTRACT This study aims to report the technique of partial cystectomy and bilateral ureteral reimplantation for resection of transitional cell carcinoma (TCC) in the trigone region of the bladder and the long-term follow-up in a Bernesse Mountain dog. The proposed surgical technique was considered viable and a potential treatment option for TCC in bladder trigone, with benefits regarding the prevention of urinary tract obstruction due to neoplastic growth and local removal of the primary tumor, which may limit or delay the spread of the disease even without adjuvant chemotherapy. The main disadvantages related to the described technique are ureteral stricture, intermittent cystitis and local relapse. However, the results are acceptable considering the long-term survival of 610 days in the case described.

An Investigation of Dosimetric Correlates of Acute Toxicity in Prostate Stereotactic Body Radiotherapy: Dose to Urinary Trigone is Associated with Acute Urinary Toxicity

AimsThere are limited data on dosimetric correlates of toxicity in stereotactic body radiotherapy (SBRT) for prostate cancer. We aimed to identify potential relationships between dose and toxicity using conventional dose–volume histograms (DVHs) and dose–surface maps (DSMs). Materials and methodsUrinary bladder trigone and rectum DSMs were produced for a single-institution service evaluation cohort of 50 patients receiving SBRT for localised prostate cancer, together with conventional DVHs for bladder and rectum. Patients had been prospectively recruited to this cohort and treated according to a pre-defined protocol to a dose of 36.25 Gy in five fractions. Radiation Therapy Oncology Group (RTOG) and International Prostate Symptom Score (IPSS) toxicity data were recorded prospectively. Logistic regression was used to identify dosimetric predictors of acute IPSS+10 (rise of 10 points or more above baseline) and grade 2+ RTOG toxicity. ResultsOn univariate analysis, trigone area receiving 40 Gy and trigone Dmax were associated with IPSS+10 (odds ratio 1.06 [1.02–1.11], P = 0.007 and odds ratio 1.54 [1.06–2.25], P = 0.024, respectively). These two variables were highly correlated. In a multivariate model, including all baseline variables, trigone Dmax remained associated with IPSS+10 (odds ratio 1.91 [1.13–3.22], P = 0.016). These findings were not significant with Holm–Bonferroni correction for multiple testing (corrected P value threshold 0.006). No associations were seen between rectal toxicity and DVH or DSM parameters. ConclusionsOur study suggests a potential relationship between high doses to the urinary bladder trigone and patient-reported urinary toxicity in prostate SBRT, and is consistent with previous studies in conventionally fractionated radiotherapy, justifying further evaluation in larger cohorts.

Aspects of lymphatic vessel configuration of the human male urinary bladder and adjacent organs: A histological basis for understanding the spread of cancer metastases

PurposeThe spread of cancer cells via lymphatic vessels (LVs) is supposed to be an early event in the dissemination process of bladder cancer metastasis. However, the configuration of LVs in the human bladder has not been extensively examined microscopically. Therefore the distribution of LVs in the bladder was investigated. Materials and methodsUsing D2-40 immunohistochemistry labeling, LVs of bladders and adjacent organs obtained from 10 donated male cadavers, in which the bladders were not dilated post mortem. ResultsThe bladder smooth muscle layer contained abundant dilated LVs, especially close to the center of the thickness of the bladder body wall. The LVs also made a delicate network in the mucosal tissue, although the density was lower than that in the smooth muscle layer. Independent from the artery and vein, LVs ran along and bundled the smooth muscles. Externally, LVs tended to run in parallel with longitudinal smooth muscles of the outer walls, especially at the posterior surface near the bladder neck. Additional LVs were traced in adjacent organs: prostate, seminal vesicles and rectum. ConclusionsThe present study indicates that clinical interventions should be attentive with the treatment of bladder cancer patients, especially considering the bladder neck or trigone area, to prevent the spread of cancer cells via LVs.

Multidisciplinary Resection of Deeply Infiltrative Endometriosis

Study ObjectiveTo describe a multidisciplinary approach for the resection of deeply infiltrative endometriosis using the robotic platform. DesignA technical video showing a step-by-step approach for the resection of deeply infiltrative endometriosis (Canadian Task Force classification level III). Institutional review board approval was not required for this study. SettingThere is considerable involvement of the bowel and bladder with deeply infiltrative endometriosis [1–3]. The need for operative procedures involving multiple organs while performing a complete resection is common. The benefits of minimally invasive surgery for a gynecologic pathology have been documented in numerous studies. Patients had fewer medical and surgical complications postoperatively, better cosmesis, and better quality of life [4–6]. We believe that deeply infiltrative endometriosis does not preclude patients from having a minimally invasive resection procedure. In this video, we describe how the robotic platform was used for a seamless transition between surgical specialties including gynecology, colorectal, and urology to ensure complete resection of endometriosis lesions involving multiple organs. PatientA 47-year-old woman with a 4-year history of severe pelvic pain, dysuria, dyspareunia, dyschezia, and dysmenorrhea failing multiple medical therapies presented to our clinic to discuss surgical options. After thorough counseling, the decision was made to proceed with definitive surgical management. Postoperatively, the patient was admitted for 2 days of postoperative inpatient care. After meeting all immediate postoperative milestones, she was discharged with an indwelling Foley catheter and instructed to follow up in the clinic with all 3 surgical specialties. At the 1-week interval, she was seen by the urology team; her indwelling catheter was removed after a cystoscopy was performed documenting adequate healing. Two weeks postoperatively, the patient was seen by the gynecology and colorectal teams and was noted to be healing adequately from the procedure. Her six-week visit was also unremarkable. She continued to follow up with the gynecology team for her yearly well-woman examinations and has been symptom free for 2 years after the surgery. She takes norethindrone daily to minimize recurrence. InterventionsPreoperative pelvic magnetic resonance imaging (MRI) showed bladder endometriosis and extensive rectovaginal endometriosis. We describe the multidisciplinary approach used for surgery and the procedures performed by each specialty. The urology team performed a cystoscopy preoperatively to assess for full-thickness erosions and the location of those lesions in that event. The urology team also reviewed the magnetic resonance images with the radiology team, and the endometriosis lesions were suspected to be close to the bladder trigone, keeping in mind that this finding could be overestimated given that the bladder was deflated at the time the imaging was obtained. Accordingly, at the time of surgery, the decision was made to proceed with cystoscopy and the placement of ureteral stents as a prophylactic measure. An intentional cystotomy and resection of the bladder section involved with endometriosis were performed followed by watertight closure. The trigone area of the bladder was not involved, and ureteral reimplantation was not needed in this case. The gynecology team operated second and performed an extensive dissection of the retroperitoneal space with the development of the pararectal and paravesical spaces. They also ligated the uterine artery at its origin followed by dissection of the uterovesical space, effectively reflecting the bladder off of the lower uterine segment. At this point, they proceeded with a total hysterectomy, and the specimen was removed from the pelvis through the vaginal cuff. Preoperatively, the colorectal surgeon ordered a colonoscopy to determine if full-thickness erosions were present and reviewed the magnetic resonance images with the radiology team. Based on the MRI and colonoscopy, all patients are counseled and consented for the possibility of a low anterior resection and loop ileostomy to protect the anastomosis. Based on the understanding that colorectal and gynecologic surgeries have a different approach when dissecting the pararectal space at our institution, a discussion between the 2 teams is initiated at the multidisciplinary session for surgery planning. In the case we present, the colorectal surgeon opted for the removal of the uterus before his dissection was initiated given that he dissects this space presacrally and not retroperitoneally like the gynecology counterpart. He would also benefit from the extra space for dissection with the uterus out of the pelvis. The colorectal part of the case was initiated by mobilization of the rectum and dissecting the obliterated rectovaginal space. The presacral space was then opened followed by mobilization of the rectosigmoid from its attachment. The case was concluded with full transection and reanastomosis of the rectum section involved with endometriosis. The specimen was also removed from the pelvis through the vaginal cuff. Measurements and Main ResultsComplete resection of deeply infiltrative endometriosis spanning beyond the scope of 1 surgical specialty. No immediate intraoperative, perioperative, or long-term complications from surgery. Complete resolution of endometriosis symptoms. ConclusionWe encourage collaborative care for planning and performing comprehensive and safe resection of deeply infiltrative endometriosis.

Octodon degus, a new model to study the agonist and plexus-induced response in the urinary bladder

Urinary bladder function consists in the storage and controlled voiding of urine. Translational studies require animal models that match human characteristics, such as Octodon degus, a diurnal rodent. This study aims to characterize the contractility of the detrusor muscle and the morphology and code of the vesical plexus from O. degus. Body temperature was measured by an intra-abdominal sensor, the contractility of detrusor strips was evaluated by isometric tension recording, and the vesical plexus was studied by electrical field stimulation (EFS) and immunofluorescence. The animals showed a diurnal chronotype as judged from core temperature. The myogenic contractile response of the detrusor muscle to increasing doses of KCl reached its maximum (31.04mN/mm2) at 60mM. In the case of cumulative dose-response of bethanecol, the maximum response (37.42mN/mm2) was reached at 3.2×10-4M. The response to ATP was clearly smaller (3.8mN/mm2). The pharmacological dissection of the EFS-induced contraction identified ACh and sensory fibers as the main contributors to this response. The neurons of the vesical plexus were located mainly in the trigone area, grouped in big and small ganglia. Out of them, 48.1% of the neurons were nitrergic and 62.7% cholinergic. Our results show functional and morphological similarities between the urinary bladder of O. degus and that of humans.

Invited Commentary

Mitral annuloplasty ring dehiscence may occur in 1% to 10% of all mitral surgeries, but can have severe and potentially fatal consequences when it does. In this issue of The Annals, Pierce and colleagues [1Pierce E.L. Siefert A.W. Paul D.M. et al.How local annular force and collagen density govern mitral annuloplasty ring dehiscence risk.Ann Thorac Surg. 2016; 102: 518-526Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar] examine the mechanisms underlying mitral annuloplasty ring dehiscence. In this manuscript, “How Local Annular Force and Collagen Density Govern Mitral Annuloplasty Ring Dehiscence Risk,” Pierce and colleagues examine causative factors governing mitral annular ring suture dehiscence in a sheep model. Possible mechanisms contributing to dehiscence such as cyclic force, loading, annular flexion, and left ventricular pressures, among others, were quantified and correlated with relative collagen density differences at multiple points around the mitral ovine annulus. From this data, a propensity for mitral annular suture pull out and force margins of safety was developed. The results showed that the anterior annular holding strength exceeded posterior annular holding strength and that the overall pullout force required exhibited a strong correlation to local collagen density. Surprisingly, trigonal sutures were less secure (less resistant to pullout) than would have been predicted or thought by the authors, due to a combination of reduced collagen in the trigonal area and higher overall annular rigidity. This goes against popular belief that the trigones are the most secure area. This finding reinforces their finding that the inter-trigonal anterior annular tissue may be a superior anchor for a mitral annular ring. This fact may help guide clinicians in selection of type of ring (complete versus partial) and for future rings and mitral prostheses. Furthermore, this manuscript is also important as it brings up more questions to be considered. For example, ring dehiscence appears to be more common in the tricuspid annular position than mitral. What are the corresponding pullout forces in the tricuspid position? Are there significant differences between the ovine and the human annulus? What happens to pullout force when the annulus is overdistended and dilated, as is often seen in human congestive heart failure. All of these questions should be examined carefully as our field moves forward to possible percutaneous therapy for mitral and tricuspid disease. Data such as in the present manuscript will help with the technology of percutaneous implantations of mitral and tricuspid rings when annular ring implantation technique no longer includes direct visualization. The scientific quantitation of long-held popular beliefs in cardiac surgery is well warranted. The questioning and validation or abandonment of our standard practice should be a continual quality process. It is in this manner that we will best serve our future mitral patients. How Local Annular Force and Collagen Density Govern Mitral Annuloplasty Ring Dehiscence RiskThe Annals of Thoracic SurgeryVol. 102Issue 2PreviewAnnuloplasty ring dehiscence is a well described mode of mitral valve repair failure. Defining the mechanisms underlying dehiscence may facilitate its prevention. Full-Text PDF

ATPS-53SURGICAL THERAPY FOR CEREBRAL VENTRICLE TUMOR IN INFANTS

BACKGROUND: Surgical treatment for infant ventricle tumors is a tough procedure. We summarize the clinical information, surgical experience and perioperative therapy for 14 patients. METHODS: The patients contained 8 males, 6 females and were treated from 2010-1 to 2014-12. The age ranged from 4 to 24 months with an average of 11.5 months. We used the approach of trigone area for 3 cases, interhemispheric transcallosal for 5 cases, and sub-occipital medline for 6 cases. RESULTS: Resection extent: 10 total resection (including 2 subtotal resection), 4 partial resection. Pathology categories: 5 choroid plexus papilomas (CPP), 1 choroid plexus carcinoma,1 mature teratoma, 1 anaplastic CPP, 3 anaplastic ependymoma (WHO III), 1 ependymoma (WHO I-II ), 1 glioma, 1 medulloblastoma. PROGNOSIS: 7 cases survive (4 cases survive with different complications); 5 infants died (all died for abandoning treatment); 1 case was lost. Overall, the prognosis is poor. CONCLUSIONS: 1. Infant cerebral ventricle tumors are often large before symptoms come up. Tumor's proximity to important brain regions makes it difficult for total resection. 2. Infants have a small blood volume and poor tolerance to operation, since great blood loss usually occurs intraoperation. Time-consuming operations, such as those for total resection, require a great deal of time under anaesthesia and blood loss. It's preferable to choose a stage operation when severe blood loss occurs. 3. Acute resection is a better choice to relieve hydrocephalus rather than drainage. 4. Close contact of qualified, specialist medical staff is necessary. Intensive care and nutritional support are important for postoperation therapy.

Urothelial Carcinoma in Pediatric Patient.

Transitional cell carcinoma as a cause of hematuria is a rare entity in the pediatric age group. An 11-year-old child presented with gross, painless hematuria. Ultrasonogram and computed tomography scan of the child revealed a tumor in the posterolateral wall of the bladder. Cystoscopically, the mass was present in the bladder away from the trigone area about 2cm lateral to the right ureteric orifice. Transurethrally, the tumor was excised by a cystoscope. Histopathologically, it was a low-grade noninvasive urothelial carcinoma of the bladder. A follow-up cystoscopy at 6months and 1year had no recurrence. Literature review revealed the pediatric age group as an uncommon age for urothelial carcinoma of bladder, which has a different biological behavior of being low malignant potential compared to their adult counterpart. They have been treated with transurethral resection of bladder tumor without any adjuvant therapy. There is no definite follow-up schedule for these tumors as it occurs in very small number of cases.

PD7-10 TURBT OF THE INTRAMURAL PORTION OF THE DISTAL URETER: PREDICTIVE FACTORS FOR SECONDARY STENOSIS AND DEVELOPMENT OF UPPER URINARY TRACT TUMOURS

INTRODUCTION AND OBJECTIVES: It is unusual to diagnose a urothelial cell carcinoma in the intramural ureter based on the visualization of papillae in the ureteral meatus or as an incidental finding during the transurethral resection of a bladder tumour (TURBT) adjacent to the ureteral meatus. We analyse the incidence of stenosis and upper urinary tract tumours (UTUC) after TURBT/excision of the intramural portion of the distal ureter and/or bladder cancer. METHODS: 112 patients, with a mean age of 69.3 13 years and a mean follow-up of 56 4 months, underwent TUR of the intramuralureter and were diagnosed with non-muscle-invasive bladder cancer (NMIBC) at that location: 58% of cases were concomitant with primary tumours. The TUR specimen of the ureteral meatus was always sent separately for histological analysis. In patients with apparent tumour remaining in the distal ureter, ureterorenoscopy was performed at 3e4 months. A double J catheter was left in patients undergoing extensive resection of the trigone area (32.1%). 22.3% and 75.9% of patients received mitomycin and BCG respectively. RESULTS: Pathological examination revealed Ta in 64%, T1 in 22.3% and CIS in 17%.17 patients (15.2%) developed UTUC, which was located in the distal ureter in 65.4%, and 13 (11.6%) a distal ureteral stenosis. The presence of a ureteral catheter did not influence the outcome (23% vs 33%, p1⁄40.45). In univariate analysis, statistically significant differences were observed between primary and recurrent tumours with respect to the incidence of symptoms (60% vs 26%, p 3 cm were associated with a higher likelihood of development of distal ureteral stenosis and CIS of the intramural portion increased the risk of UTUC. Closer follow-up of should be undertaken since these factors are associated with a higher incidence of upper urinary tract problems.

Laparoscopic Repair of Intrapartum Concomitant Bladder and Uterine Rupture

A 38 y/o pregnant woman, G2P1, with unscarred uterus (no previous uterine surgery),vaginally delivered her 2nd baby in a seemed smooth course. But in the postpartum period, PPH and gross hematuria were noted. Concomitant bladder and uteirne rupture were noted. Laparoscopic intervention was performed, to repair the bladder and uteirne laceration hole, preventing the future formation of vesico-uterine fistula. Baby OG tubes were introduced to catheterized bilateral ureters, because the bladder laceration wound was so closed to trigone area. Both uterine wall and bladder wall were successsfully repaired under laparoscopic surgery. Concomitant bladder and uterine rupture in an unscarred multi-parous uterus is extremely rare. The technical tpis for safe repair of the bladder and uterine laceration wound will be demonstrated in this video.

Indiana pouch in children: A 15-year experience

ObjectiveWe report our experience with the Indiana pouch (continent urinary reservoir) in 12 consecutive children over the last 15 years and report their follow-up. Material and methodsTwelve consecutive children, who underwent the continent urinary reservoir procedure in the form of an Indiana pouch, were prospectively enrolled in the study. All consecutive children who were referred to our service with multiple failed surgeries for exstrophy–epispadias repair, cloacal exstrophy, genitourinary rhabdomyosarcoma with residual disease in the trigonal area not amenable to partial cystectomy, and neuropathic bladder with nephrogenic metaplasia were included over the period 1997–2012. All these children were offered the same form of bladder substitution (Indiana pouch) as described by the Indiana group many years ago. Postoperative care was on a fixed protocol, and follow-up details recorded over the years. They were followed up for dry interval with clean intermittent catheterisation, social acceptance, and early and late complications. ResultsOut of these 12 patients (7 males and 5 females), eight patients had exstrophy–epispadias with multiple failed operations carried out elsewhere, cloacal exstrophy (2), residual rhabdomyosarcoma in the trigonal area with incontinence following chemotherapy (1), and neuropathic bladder with recurrent diffuse neoplastic polyposis (1). In the follow-up period of 1–15 years (median 24 months) all the patients had a dry interval of 4 h or more with clean intermittent catheterisation. One patient had wound dehiscence during the postoperative period and another required stomal revision 1 year after initial surgery. ConclusionsThe Indiana pouch is a reliable, safe, and effective form of bladder substitution. It can be reconstructed in a wide range of lower urinary tract disorders. In the vast majority of children with multiple failed surgical procedures for exstrophy–epispadias, the Indiana pouch is a safe, reliable, and reproducible procedure to provide a socially acceptable quality of life with a dry interval of 4 h.

Atypical squamous cells in the urine revealing endometrioid adenocarcinoma of the endometrium with squamous cell differentiation: A case report

Urine cytology is mainly used to detect urothelial carcinoma (UC), especially for high-grade lesions including urothelial carcinoma in situ. Benign squamous cells are often seen in the urine specimens of women, they are either exfoliated from the trigone area of the bladder, the urethra, or the cervicovaginal region. However, abnormal squamous cells in the urine raise concerns of abnormalities of the urinary tract and cervicovaginal area which range from squamous metaplasia of the urothelium, a cervicovaginal squamous intraepithelial lesion, condyloma acuminatum of the bladder, UC with squamous differentiation, and squamous cell carcinoma. We present here a unique case of atypical squamous cells (ASCs) in the urine subsequently leading to the diagnosis of endometrioid adenocarcinoma of the endometrium with squamous differentiation. The presence of ASCs in voided urine is a rare finding that may indicate an underlying malignancy. Careful evaluation of squamous cells in the urine is an important part of our daily cytopathology practice.

Endoscopic temporal ventriculocisternostomy: an option for the treatment of trapped temporal horns

Entrapment of the temporal horn is a rare form of isolated hydrocephalus. Standard treatment has not yet been established for this condition, and only a few cases have been reported in the literature. The authors reviewed their prospectively maintained database to report their experience with endoscopic temporal ventriculocisternostomy. All endoscopic operations performed in the Department of Neurosurgery at Ernst Moritz Arndt University between March 1993 and August 2012 were reviewed, and a retrospective chart review of all patients with temporal ventriculocisternostomy was performed. Four patients were identified (3 children and 1 adult). In 3 patients, the condition developed after tumor resection, and in 1 patient it developed due to postmeningitic multiloculated hydrocephalus. In 2 patients, a recurrent trapped temporal horn developed. Refenestration was successful in one of these patients, and dilation in the trigone area with a subsequent stomy of the septum pellucidum was successful in the other. In 1 patient, postoperative meningitis developed, which was treated with antibiotics. Endoscopic temporal ventriculocisternostomy is an option in the treatment of trapped temporal horns. However, more experience is required to recommend it as the treatment of choice.

Schistosomiasis as a cause of terminal haematuria in a 14 year old boy in UK

Urinary schistosomiasis is one of the main public health problems in Africa and the Middle East. Schistosomiasis (Bilharziasis) seems to be on the rise in developed countries like United Kingdom with the continuing influx of immigrants and refugees, as well as the return of travellers and soldiers from endemic areas. We present case report from UK, of a 14 year old Asian boy, who presented to a general paediatrician with a two month history of painless, gross, terminal haematuria. He also had general symptoms of malaise, early fatigability with poor appetite and was a known carrier of thalassemia trait. On Full blood count, his haemoglobin was 11.4 gm/dl with eosinophilia 0.71×109 (Normal range 0.04-0.40). An ultrasound scan of urinary tract revealed localised thickening of bladder located towards the trigone. This raised suspicion of rhabdomyosarcoma of bladder. An urgent cystoscopy was performed which revealed multiple lesions in the area of trigone, studded with white spots within the lesion. Punch biopsy was done which showed eggs of Schistosomia haematobium and the inflammatory mass constituted eosinophilic infiltration. History was revisited and it was discovered that he had travelled to Malawi, where his father was working. As a treatment two doses of Praziquantel was given and patient will be followed up with ultrasound scan later to assess the bladder lesions.

Schistosomiasis as a cause of terminal haematuria in a 14 year old boy in UK

Urinary schistosomiasis is one of the main public health problems in Africa and the Middle East. Schistosomiasis (Bilharziasis) seems to be on the rise in developed countries like United Kingdom with the continuing influx of immigrants and refugees, as well as the return of travellers and soldiers from endemic areas. We present case report from UK, of a 14 year old Asian boy, who presented to a general paediatrician with a two month history of painless, gross, terminal haematuria. He also had general symptoms of malaise, early fatigability with poor appetite and was a known carrier of thalassemia trait. On Full blood count, his haemoglobin was 11.4 gm/dl with eosinophilia 0.71×109 (Normal range 0.04-0.40). An ultrasound scan of urinary tract revealed localised thickening of bladder located towards the trigone. This raised suspicion of rhabdomyosarcoma of bladder. An urgent cystoscopy was performed which revealed multiple lesions in the area of trigone, studded with white spots within the lesion. Punch biopsy was done which showed eggs of Schistosomia haematobium and the inflammatory mass constituted eosinophilic infiltration. History was revisited and it was discovered that he had travelled to Malawi, where his father was working. As a treatment two doses of Praziquantel was given and patient will be followed up with ultrasound scan later to assess the bladder lesions.

Simultaneous transurethral resection of a bladder tumor and benign prostatic hyperplasia: Four case reports and literature review

To evaluate the recurrence of a bladder tumor on the prostate fossa and bladder neck in patients undergoing simultaneous transurethral resection of a bladder tumor (TUR-BT) and benign prostatic hyperplasia (BPH) in our hospital, we retrospectively studied four patients who underwent simultaneous TUR-BT and transurethral resection of the prostate (TUR-P) in 2001 to 2004. The pathology was confirmed histologically to be transitional cell carcinoma of the bladder tissue or atypia cells and BPH. Two patients had bladder tumor recurrence at 18 and 33 months during the postoperative follow-up period (10–36 months, with a mean of 18.5 months). One at the bladder neck recurred 33 months postoperatively, and the other in the trigone area, near the bladder neck, recurred after 18 months. After another TUR-BT, there were no more recurrences in these two patients. No tumor progressed to the invasive stage. Tumor recurrence on simultaneous TUR-BT and TUR-P patients is a key issue of concern. We present a brief history of the four patients and a literature review. We concluded that conducting the two procedures simultaneously is clinically feasible for selected patients.

Bladder Wall Thickness is Associated with Responsiveness of Storage Symptoms to Alpha-Blockers in Men with Lower Urinary Tract Symptoms

PurposeBladder wall thickness (BWT) is reported to be related to detrusor overactivity and bladder outlet obstruction. We investigated the relationship between BWT and the responsiveness of storage symptoms to alpha-blockers in men with lower urinary tract symptoms (LUTS).Materials and MethodsA total of 74 patients with LUTS were enrolled. International Prostate Symptom Score, uroflowmetry with post-void residual urine volume, and transrectal ultrasonography (TRUS) were investigated. BWT was measured by performing TRUS at the midsagittal plane view, and the average value of BWT at the anterior, dome, and trigone areas was used. After 4 weeks of alpha-blocker medication, patients were reevaluated and divided into two groups. The responder group consisted of patients who reported improvement in the storage symptom subscore of 2 points or more; the non-responder group consisted of patients who reported improvement of less than 2 points. Clinical parameters including BWT were compared between the two groups.ResultsA total of 52 patients were followed. BWT was positively correlated with intravesical prostate protrusion (IPP) (9.26±4.99, standardized beta=0.393, p=0.002) and storage symptom subscore (0.35±0.43, standardized beta=0.458, p=0.002). Compared with that in the responder group, BWT was thicker in the non-responder group, and improvement in the storage symptom score was correlated with BWT (0.58±0.09 cm vs. 0.65±0.11 cm, p=0.018) and prostate volume (27.08±16.26 ml vs. 36.44±10.1 ml, p=0.018).ConclusionsBWT was correlated with IPP, the storage symptom subscore, and the responsiveness of storage symptoms to alpha-blockers in LUTS/benign prostatic hyperplasia (BPH) patients. As BWT increased, the responsiveness of storage symptoms to alpha-blocker decreased in LUTS/BPH patients.