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The extrapulmonary manifestations of Coronavirus Disease 2019 (COVID-19) are common. However, radiological reports presenting urinary tract abnormalities related to COVID-19 were not widely published. We present a case of a female patient with a mild course of the COVID-19 disease, which affected the entire urinary tract. CT scanning showed inflammatory kidney changes with multiple ureter and bladder blood clots accompanied by a decrease in renal function. A literature review found only several publications that included imaging of urinary tract manifestations of COVID-19, generally presenting as renal infarctions due to a COVID-19 related hypercoagulability state. Also, there is evidence of some discrete changes in renal parenchymal CT attenuation values due to kidney inflammation in COVID-19 patients. However, imaging of other parts of the urinary system, with the exception of the kidneys, are rarely described to be affected by COVID-19. More clinical attention is needed to diagnose the unknown aspects of the disease., Ekstrapulmonalne manifestacije bolesti uzrokovane koronavirusom otkrivenim 2019 (COVID-19) su brojne. Ipak, radiološki prikazi manifestacija COVID-19 na mokraćnom sustavu nisu česti u postojećoj literaturi. Ovaj prikaz slučaja predstavlja pacijenticu s blagim simptomima COVID-19, koji se komplicirao promjenama na cijelom mokraćnom sustavu. CT presjeci su pokazali upalne promjene bubrega te brojne ugruške mokraćovoda i mokraćnog mjehura, što je bilo praćeno oslabljenom bubrežnom funkcijom. Pregled literature pronašao je nekoliko publikacija, koje su uključivale slikovnu dijagnostiku zahvaćenosti mokraćnog sustava tijekom COVID-19, a uglavnom je bila riječ o infarktu bubrega povezanog s hiperkoagulabilnim stanjem, koje se javlja u COVID-19 pacijenta. Također, postoje dokazi o diskretnim promjenama CT atenuacijskih vrijednosti bubrežnog parenhima u pacijenata s COVID-om, uzrokovanim prvenstveno upalnim promjenama bubrega. Izuzev bubrega, manifestacije na drugim dijelovima mokraćnog sustava gotovo da nisu prepoznate i opisane. Potrebna je veća klinička pažnja kako bi se dijagnosticirali nepoznati aspekti bolesti mokraćnog sustava tijekom COVID-19 infekcije.

Primary malignant melanoma of the urinary bladder is rare, with only 20 cases reported to date. We present a case of an 87-year-old woman with multiple comorbidities who presented with advanced urinary bladder neoplasm. Histopathologic analysis suggested melanoma of the urinary bladder. No previous or concurrent diagnosis of cutaneous melanoma was documented. The patient underwent transurethral resection of the tumor before and during hospitalization at our hospital but died shortly after due to widespread disease. Autopsy was not performed., Primarni melanom mokraćnog mjehura je rijetka bolest, s 20-ak opisanih slučajeva u literaturi. U ovom radu prikazujemo 87-godišnju bolesnicu s brojnim komorbiditetima, a koja se javila u našu bolnicu s uputnom dijagnozom proširene tumorske bolesti mokraćnog mjehura. Patohistološka analiza otkrila je melanom mokraćnog mjehura, a treba istaknuti da bolesnica nikada nije imala dijagnosticiran melanom kože. Bolesnica je liječena transuretralnom resekcijom prije i tijekom hospitalizacije u našoj bolnici, gdje je nakon kraćeg vremena i preminula zbog uznapredovale bolesti. Obdukcija nije učinjena.

The present study was undertaken to determine the effects of erythromycin on urinary bladder muscle contractions in hyperthyroid rats. Totally 12 rats were assigned into 2 groups (6 rats in each group), as the control and hyperthyroid rat groups. The contractile responses were determined as Emax and pD2 of carbachol (10-3-10-8 M) and potassium (1-6×10-2 M, KCl) in the absence and presence of erythromycin (10-3; 5×10-4; 10-4 M). The contractile responses to carbachol (10-3-10-8 M) in the presence of verapamil (10-8 M), atropine (10-8 M), or in calcium-free Krebs solution were also determined in the absence and presence of erythromycin (10-3 M). Treatment of erythromycin significantly reduced the response to carbachol and KCl-evoked contractions. Carbachol-evoked contractions were reduced in the presence of atropine, whereas the atropineresistant components of carbachol-evoked contractions were not inhibited in the presence of erythromycin. The contractile response to carbachol was reduced in calcium-free Krebs solution and 10-8 M verapamil. In addition, when erythromycin was added together with verapamil 10-8 M, the contractile response to carbachol was inhibited. In conclusion, erythromycin more effectively inhibited urinary bladder contractions in hyperthyroid rats than the control rats, through calcium movement inhibition., Istraženi su učinci eritromicina na kontrakcije mišića mokraćnog mjehura u hipertireotičnih štakora. Dvanaest štakora bilo je svrstano u dvije skupine, kontrolnu i pokusnu (po šest štakora u svakoj skupini). Kontraktilni odgovor izražen kao Emax i pD2 na karbakol (10-3-10-8 M) i kalij (1-6×10-2 M, KCl) bili su određeni u odsutnosti i prisutnosti eritromicina (10-3; 5×10-4; 10-4 M). Kontraktilni odgovori na karbakol (10-3-10-8 M) u prisutnosti verapamila (10-8 M), atropina (10-8 M), ili u Krebsovoj otopini bez kalcija, bili su također određivani u odsutnosti i prisutnosti eritromicina (10-3 M). Primjena eritromicina značajno je smanjila odgovor na kontrakciju potaknutu karbakolom i kalijevim kloridom. Kontrakcije potaknute karbakolom bile su smanjene u prisutnosti atropina, dok komponente kontrakcija izazvane karbakolom rezistentne na atropin nisu bile inhibirane u prisutnosti eritromicina. Kontraktilni odgovor na karbakol bio je smanjen u Krebsovoj otopini bez kalcija i 10-8 M otopini verapamila. Povrh toga, kontraktilni odgovor na karbakol bio je inhibiran kad je eritromicin bio primijenjen zajedno s 10-8 M verapamilom. Može se zaključiti da je eritromicin učinkovitije inhibirao kontrakcije mokraćnog mjehura hipertireotičnih štakora nego u kontrolnih štakora putem inhibicije kolanja kalcija.

Foreign bodies inside urinary tract are a relatively rare condition in our practice. There are several reports published and in most cases the reason for self insertion of an object was autoerotic stimulation or psychiatric illness. Self treatment by homemade instruments is a rarely seen scenario. A 62-year-old man presented to our department complaining of lower urinary tract symptoms. On examination, a foreign body was detected inside the urinary bladder. Urethral stricture was also detected for which the patient had been previously treated on several occasions. The patient stated that he had attempted self catheterization using a homemade catheter. He had succeeded in emptying his bladder; however, the catheter entered the bladder completely and was irretrievable to him. Sachse urethrotomy was performed following retrieval of the foreign body. No psychiatric illness was detected in our patient. The patient’s postoperative course was uneventful., Strana tijela unutar mokraćnog sustava su relativno rijetko stanje u našoj praksi. U većini objavljenih slučajeva razlog umetanja stranog tijela je autoerotska stimulacija ili psihijatrijska bolest. Umetanje stranog tijela kao povod za rješavanje mokraćne opstrukcije je rijedak događaj. Bolesnik u dobi od 62 godine javio se na našu kliniku zbog simptoma donjeg mokraćnog trakta. Tijekom pregleda otkriveno je strano tijelo unutar mokraćnog mjehura. Kod bolesnika je u više navrata rađena unutarnja uretrotomija, a jednom otvorena operacija uretre s terminoterminalnom anastomozom. Bolesnik je naveo da je pokušao samokateterizaciju s improviziranim kateterom. Uspio je riješiti mokraćnu opstrukciju, no dio stranog tijela je zaostao u mokraćnom mjehuru. Nakon dodatne obrade učinjena je unutarnja uretrotomija po Sachseu s ekstrakcijom stranog tijela iz mokraćnog mjehura. Psihijatrijskih bolesti se kod bolesnika ne nalazi.

Bladder carcinoma in situ (CIS) is a rare, high-grade intraepithelial neoplasm with a high tendency of progression and unpredictable clinical course. The aim of this study was to evaluate the incidence, treatment and clinical outcome of patients with CIS during a 10-year period. Medical records of 1062 patients with primary bladder cancer and 847 patients with recurrent bladder cancer that underwent tumor resection at Department of Urology, Split University Hospital Center, Split, Croatia, between January 2001 and December 2010, were analyzed. Among all treated patients with primary bladder neoplasms, 51 (4.8%) had CIS. Primary CIS was diagnosed in 18 (1.7%) and concomitant CIS in 33 (3.1%) patients. In the same period, 847 patients with recurrent tumors were treated by transurethral resection (TUR), 12 (1.4%) of them with secondary CIS. Clinical course was followed-up in 15 patients with primary CIS and 21 patients with concomitant (TaT1) CIS. BCG immunotherapy was applied in 12 patients with primary and 17 patients with concomitant CIS. After median follow-up of 50 months, 9 patients with primary CIS had no sign of disease, 4 progressed, 1 had recurrence and 1 died. After median follow-up of 37 months, 13 (62%) patients with concomitant CIS had complete response, 3 progressed (14%), 1 had recurrence (4%) and 4 patients died, however, only 2 (10%) of these due to bladder cancer. Of all patients receiving BCG immunotherapy, 8 (27%) had significant side effects. The incidence and treatment of patients with CIS of urinary bladder in our institution is comparable to other recent literature reports.

MIkropapilarni urotelni karcinom (MUK) je rijetka varijanta urotelnog karcinoma mokraćnog mjehura (UK) koja ima veoma agresivno ponašanje. U ovoj studiji analizirali smo kliničkopatološka obilježja MUK, posebno odnos između patohistološkog stupnja u trenutku otkrivanja bolesti i udjela mikropapilarne komponente (MPK) u pregledanom materijalu za 10 bolesnika koji su liječeni zbog urotelnog karcinoma mjehura u razdoblju od 1.1.2004.-30.6.2007. u KB Sestre Milosrdnice. U promatranom razdoblju bilo je 610 bolesnika s UK mjehura (M:F=456:154) od kojih je 10 imalo MUK. Svi mikropapilarni urotelni karcinomi bili su u invazivnom stadiju bolesti u vrijeme postavljanja dijagnoze. Raspodjela po stadijima bila je 4T1 (40%) i 6 T2 (60%), a udio MPK bio je: u 3 od 4 (75%) T1 tumora manje od 10% MPK, dok je u 5 od 6 (83, 2%) T2 tumora bilo više od 50% MPK. MUK je agresivni tumor, obično u uznapredovalom stadiju u vrijeme otkrivanja bolesti, kod kojeg je patološki stadij povezan s udjelom MPK u tumoru.

Invasive carcinomas are usually accompanied with stromal response in which myofibroblasts may have an important role. Such a reaction may not be present in in situ carcinomas that are in majority of cases associated with lymphocytic reaction. The aim of this study was to analyze the presence and quantity of myofibroblasts in in situ and invasive urothelial carcinoma of the bladder. Urological pathology registry at the Ljudevit Jurak University Department of Pathology was canvassed for patients with both, in situ and invasive urothelial carcinoma. Relevant patient data including age, sex, tumor grade and stage of the disease were analyzed. All cases were examined by routine histology. In this study we analyzed the expression of alpha smooth muscle actin and vimentin as imunohistochemical markers for myofibroblasts. The intensity of reaction was graded semiquantitatively and expresssed as (-) for negative, (+) for weak staining, (++) for moderate and (+++) for strong staining. In the period from 1998-2002 there were 1243 biopsies with the diagnosis of urothelial carcinoma. Thirty-three biopsies with urothelial carcinoma in situ were found. We identified 10 patients with both in situ and invasive carcinoma. All of them were males ranging in age from 61-77 years (mean age 70.2 years). Imunohistochemical analysis revealed that in cases of invasive urothelial carcinoma reactive stromal cells are alpha smooth muscle actins positive indicating the myofibroblast phenotype. In areas with in situ carcinoma the intensity of SMA reaction was moderate in 3 cases, weak in 5 cases and negative in 2 cases and intensity of vimentin reaction was strong in 2 cases, moderate in 7 cases and weak in 1 case. In areas with invasive carcinoma the intensity of SMA reaction was strong in 5 cases and mild in 5 cases and intensity of vimentin reaction was strong in all of 10 cases. We found that the expression of myofibroblastic markers was strong in stroma of invasive carcinoma but absent or weak in in situ urothelial carcinoma. This finding may indicate a role of myofibroblasts in the stromal reaction to invasion but may also be useful in diagnosis of in situ versus invasive urothelial carcinoma. Further studies on larger groups of tumors are certainly needed.

U uvodu je dat prikaz incidencije, mehanizma povrede, patološkog supstrata, simptomatologije, kao i prikaz dijagnostičkih metoda i terapeutskih postupaka kod perforativnih povreda mokraćnog mjehura. Govori se također o prognozi i kasnim posljedicama. Na odjelu za urologiju u Vinkovcima, u proteklih 15 godina, operirano je 11 zatvorenih povreda mokraćnog mjehura i 1 prostrijelna povreda mokraćnog mjehura i rektuma. Prikazan je bolesnik sa strijelnom povredom mokraćnog mjehura i rektuma kao raritet u mirnodopskim uvjetima. Istaknuta je uspješna suradnja kirurškog i urološkog operativnog tima u zbrinjavanju povrede mokraćnog mjehura i rektuma. Opisan je suprapubični pristup radi zbrinjavanja prednje i stažnje stijenke mokraćnog mjehura i prednje stijenke rektuma, kao i sakralni pristup sa ekstirpacijom trtične kost i radi evakuacije stranog tijela (metak) i zbrinjavanja stražnje stijenke rektuma. Šest mjeseci nakon opsežnog operativnog zahvata, rezultirala je litijaza mokraćnog mjehura kao kasna komplikacija. U kasnijem toku bolesnik nije imao mikcionih i drugih tegoba., A review of frequency, matter of traumatism, pathologic substrats and a review of diagnostic and therapeutic procedures in perforative lesions of the urinary bladder are given. The prognosis and further complications are also discussed. A patient with a gunshot wound of the urinary bladder and rectum is presented as a rare case in the peace-time situations. The good correlation within surgical and urologic teams in sanation of the perforative lesion of the urinary bladder and rectum is stressed. Suprapubic exposure for the operative procedure on the bladder and the anteror wall of the rectum is presented as well as the sacral view with excision of the coccygis for the posterior rectum wall and the extirpation of the metall foreign body. Six months after the major surgery has been performed a calculosis of the urinary bladder is diagnosed as a late complication. After sanation of this lesi on the patient has been quite well.