Search

A case of neonatal urinary ascites secondary to urethral valves is presented and the recent literature reviewed. The majority of infants with urinary ascites appearing in the first few weeks of life have good renal reserve and often a less dilated urinary tract than others with urethral valves in the first month of life. A possible explanation for this is suggested, and the therapeutic implications are discussed.

This paper reports a method of examination of patients presenting with symptoms or urographic changes suggesting bladder neck dysfunction, ureterovesical reflux, and/or chronic or repeated bouts of urinary tract infection. The need for improved methods for investigation of these patients is discussed, the technic is described, and initial results are reported. The difficulty of assigning a cause for the numerous instances of upper urinary tract dilatation that result in destruction of the parenchyma of the kidney has received increased attention in recent years, particularly where the abnormality has been observed in patients with recurrent infection or neurologic disorders. Knowledge of the mechanisms that cause ureteral reflux and bladder outlet obstruction has been increased by many clinical and basic studies (1–13). Observations of isolated physiologic specimens, while providing basic information, have not permitted the evolution of a satisfactory classification or theory to explain the wide spectrum ...

Urinary reflux needs careful evaluation and prompt treatment. Presenting complaints include failure to thrive, and/or recurrence of a urinary tract infection. If bladder outlet obstruction is present

Embryonal sarcoma of the prostate is a rare tumour in children; four cases treated at our hospital form the basis of this report. The usual mode of presentation is progressive bladder outlet obstruction often combined with infection. The importance of careful clinical check up and rectal digital examination in acute urinary obstruction has been stressed. Prompt investigations including an excretory pyelogram and a voiding cystogram are suggested. Histological evidence of the presence of the tumour should be obtained either by a transurethral or by a transvesical frozen section biopsy. Aggressive radical surgery combined with irradiation and actinomycin D appears to offer the best hope for long term survival.

Summary 34 children with myelomeningocele were operated by a technique of “closed” external sphincterotomy (without opening the urethra). Bladder expression was made easier in 25 out of 30 patients available for follow up. The effects of operation on the volume of residual urine, reflux and dilatation of the upper renal tract were not consistent. It is not easy to predict which cases are likely to respond to this operation sufficiently well to justify its general use for bladder outlet obstruction at external sphincter level in spina bifida.

Urine ascites usually presents at birth or shortly thereafter and is associated with a high overall mortality rate. Posterior urethral valves are the most common obstructive lesions. Prompt recognition is vital if the survival rate is to be improved. Two unusual cases of urine ascites are presented. A stillborn premature infant with imperforate anus and massive ascites showed radiologic evidence of peritoneal calcification. A prepartum diagnosis could have been made from the radiographs of the maternal abdomen. The second case is unique in the presentation of urine ascites caused by a presacral neuroblastoma that produced bladder outlet obstruction and perforation.

Background: Transurethral resection of the prostate underwent significant technical improvements during the last decades, with major impact on the incidence of intra and postoperative complications. Objectives: The objective of the study was to analyse the early complications and to predict immediate outcomes of transurethral resection of prostate (TURP) in a single tertiary care institute. Materials and methods: We prospectively evaluated 100 patients undergoing transurethral resection of prostate at B and B Hospital, Gwarko, Lalitpur, Nepal, from August 2008 till April 2009. Case records containing 32 variables concerning preoperative status, operative details, complications and immediate outcome were recorded for each patient. Results : The cumulative short-term postoperative significant morbidity was 10% and the peroperative morbidity was 6%. The most relevant postoperative complication was failure to void (24%). Among significant postoperative morbidities, surgical revision had to be performed in two patients (2%), open prostatectomy in one patient, transurethral resection (TUR) syndrome in 5% and significant urinary tract infection in 2%. Among significant intra operative morbidity, we had one case with bladder perforation, significant cardiac arrhythmia requiring prompt attention in 4% and TUR syndrome during resection in 1%. We did not have any mortality related to the procedure during the study period. The resected tissue averaged 25.67gm. Incidental carcinoma of the prostate was diagnosed by histological examination in 4% of patients. Urine peak flow rate (Q-max) increased to 12.88ml per second from 9.24ml per second and average fl ow rate increased to 7.36 ml per second from 5.03 ml per second. The postoperative mean residual urine measured by ultrasound decreased to 28.46ml from preoperative 86.59 ml. Conclusions: TURP has, for decades, been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia though significant morbidities can be associated with the procedure. Meticulous preoperative workup and proper selection of the patients for the procedure significantly improve the outcome after transurethral resection of the prostate. Key words: TURP ( Transurethral resection of prostate); LUTS ( Lower urinary tract symptoms); BOO (Bladder outlet obstruction) DOI: 10.3126/kumj.v8i2.3559 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 203-207

Objectives: Transurethral resection of prostate (TURP) is the gold standard treatment for symptomatic prostatic bladder outlet obstruction. Haemorrhage during and after TURP can lead to significant morbidity and mortality. The purpose of this study was to assess the influence of anaesthesia, operating time, weight of resected prostatic tissue and its histology on blood loss during and after TURP and to revisit the available body of evidence in the literature of urology. Materials and methods: This is a prospective study of a cohort of 100 consecutive patients who had undergone TURP over a period of one year, where the data was collected on a performa specifically designed for the study, which included the type of anaesthesia administered, resection time, amount of blood lost during and after TURP, weight of the resected prostatic tissue and histology. Results: Sixty seven patients underwent TURP under spinal anaesthesia (SA) and 33 under general anaesthesia (GA). The median intraoperative (SA: 89.95 (5-936); GA: 105.40 (5-517) mls), postoperative (SA: 72.37 (15-387); GA: 136.43 (11-969) mls) and total (SA: 162.32 (29-1200); GA: 241.83 (21-1251) mls) blood losses were not significantly different between the two groups (95% C.I. -9.90 to 19.22, p= 0.46). The total operating time (SA: 29.70 (10-55); GA: 29.80 (10-65) minutes) and weight of resected prostate (SA: 21.90 (3-45); GA: 18.00 (4-60) gms) were similar between the two groups. There was a trend towards increased blood loss when BPH was associated with prostatitis (N=8). Of these, 3 patients required blood transfusion as compared to 1 patient in rest of the group, although this was not statistically significant (95% C.I - 67.2 to 1120.4, p = 0.87). Conclusions: The intraoperative, postoperative and total blood losses related to TURP were not influenced by the type of anaesthesia, resection time, weight of the resected prostate and the histology. Key Words: Transurethral resection of prostate, blood loss, anaesthesia, prostatitis, carcinoma, aspirin doi: 10.3126/kumj.v6i3.1707 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 329-334

SUMMARY A case is reported of the Ehlers–Danlos syndrome in which the well–known cutaneous and orthopaedic manifestations were accompanied by bladder outlet obstruction and diverticulum of the bladder, which were successfully relieved by operation. We should like to thank Mr John Blandy for his kind permission to publish this case, and Mr Ruddick, from the Department of Photography, The London Hospital.

Summary The size of the prostate gland in 15 patients presenting with bladder outlet obstruction due to benign prostatic hypertrophy was determined by digital examination, by analysis of the bladder films of intravenous pyelograms and by ultrasonic scanning of the prostates. It is concluded that ultrasonic scanning is the most accurate method for determining prostate gland size.

Most patients with bladder outlet obstruction present themselves with clear-cut symptoms, so that diagnosis is easy. There is a substantial group of patients who have vague or bizarre urinary tract symptoms and in whom the possibility of bladder outlet obstruction should be considered when no other cause for the symptoms is apparent. These patients should undergo pyelographic, cystourethroscopic, and urethrographic examination. Direct measurement of intravesical pressures during urination is valuable in diagnosing vesical outlet obstruction which is not revealed by other diagnostic methods. This procedure has also proved useful in evaluating the various methods of treatment.

Today the urologist treating a patient having recurrent urinary tract infections performs voiding cystourethrography almost as routinely as excretory pyelography (IVP) and cystoscopy. The high yield of vesicoureteral reflux, paraureteral diverticula, and bladder outlet obstruction has stimulated much creative work searching for cause and best treatment of these congential disorders.

Newborn infants with posterior urethral valves usually present clinically with non-specific symptoms and signs (Williams, 1968). Radiographic findings, however, are usually confined to the urinary tract. An exception is massive ascites, which is a rare complication of posterior urethral valves or other lesions causing bladder outlet obstruction (see Bibliography). Another non-urinary tract radiographic finding which we encountered in a newborn baby with posterior urethral valves was a large pleural effusion. Abnormal amounts of urea nitrogen were present in the pleural fluid, suggesting that it contained urine. This occurrence has not been reported previously. The patient, a newborn male, was the product of a normal pregnancy, birth and delivery of a Gravida 5 Para 4 mother. Birth weight was 5 lb. 4 oz. During the first three weeks of life the infant did not gain weight and gradually developed dyspnoea and cyanosis. The mother noted constant dribbling of urine and observed that the infant did not void in ...

SUMMARY The mode of action of the bladder sphincter is not known but it seems to be more than a simple mechanical valve and may depend at least in part on some orderly pattern of muscular contraction, possibly of peristaltic nature, under autonomic control. A minor procedure for dealing with meatal stricture is described. Bougies a boule have been found of great assistance in the investigation of the female urethra, and passage of these bougies has been found to be the best method for demonstrating and locating a stricture. Very little mechanical strength is required to narrow the urethra and the fact that no stricture is detected by the passage of a cylindrical instrument is not valid evidence of the absence of a stricture. In the cine cystourethrogram a narrowing, with dilatation above, suggests the presence of a stricture, but strictures are not always displayed by this technique. In the short term, internal urethrotomy appears to be a most useful procedure for dealing with strictures, but it will be many years before its long term value will be fully assessed. The operation is simple and appears to be remarkably safe. YV-plasty should not be performed on the adult female except after the most careful and extensive investigation.

Radiotherapy is an effective tool for the palliation of symptoms commonly caused by prostate cancer. The majority of painful bone metastases respond equally well to single or multiple fractions of external radiotherapy. Retreatment with a second course of radiation induces pain responses in approximately 50% of patients. For more diffuse metastases, either hemibody radiation or systemic radiopharmaceuticals can reduce pain, and radium-223 is associated with improved survival in men with castration-resistant prostate cancer. Hematuria, bladder outlet obstruction, and rectal compression are all improved with palliative radiotherapy. The ability of stereotactic body radiation therapy to reduce pain compared with standard external radiation is being investigated, as is its role in treating those with limited metastatic disease.

Our experience with bladder tumors in children is presented and the pertinent literature reviewed. Nonepithelial tumors are more common than epithelial ones, and the most common symptom is bladder outlet obstruction. Papilloma, the common epithelial tumor, usually presents with hematuria and is successfully treated by transurethral methods. Treatment of bladder neurofibroma will depend on the site and size of the tumor and on resultant symptoms and obstruction; small or moderate-size nodules may be amenable to transurethral resection, local excision, or segmental resection, but for diffuse involvement of the bladder, total cystectomy may be necessary. Hemangiomas are the most common benign connective tissue tumor, and their common location in the upper part of the bladder usually permits successful treatment by open excision or segmental resection. Rhabdomyosarcoma is the most common bladder tumor in children. On present evidence radical cystectomy is the treatment of choice. The contributions of adjunct radio- and chemotherapy are not well defined, but such treatment is recommended since it has contributed to the control of tumor in nonresectable cases. Four of 8 patients in this series are alive and well five and one-half to seventeen years, 3 having had radical cystectomy (with radiotherapy in 2 and chemotherapy in 1) and 1 segmental resection with radio- and chemotherapy. Leiomyosarcoma of the bladder has been controlled by segmental resection, but it is logical to believe that radical cystectomy would extend the possibilities of surgical control in some cases; adjunct irradiation and chemotherapy may deserve a place in treatment as well.

Objective: The prostate volume is an objective due to BPH diagnosed, however it is not always concerned with the LUTS degree. LUTS is a syndrome of BOO which marked by obstructive and irritable symptoms. The ball valve mechanism in bladder neck results in increasing of BOO. The aim of this study is to prove the relation of intravesical prostatic protrussion (IPP) with prostate volume, Q max, and international prostate symptom score (IPSS) in non complicated BPH LUTS patients. Materials and method: This research is an analysis observational that involved 85 male patients aged 50 to 91 years old (average 63,98 years old) in Urology Outpatient Clinic RSUD Dr. Soetomo, starting November 2007 until April 2008. Such IPSS evaluation, prostate volume measurement, uroflowmetry examination, and IPP examination with TAUS were applied to all of these patients. Results: The calculation shows the increasing of IPP degree followed by the decreasing of Q max value, where Spearman rank correlation indicates r=-0,465 with p=0,001 (smaller than 0,05), which shows the relation between IPP and Q max. In Spearman rank correlation, with the IPP degree increasing followed by IPSS value increasing indicates r=0,456 and p=0,001, which is smaler than 0,05. Also shows the increasing of IPP degree followed by prostate volume increasing, with r=0,230 and p=0,034 is smaller than 0,05 in Spearman rank correlation. Conclusion: The research reveals a connection between IPP degree and Q max, where the higher IPP degree the lower Q max value, the higher IPP degree the bigger IPSS value, and the higher IPP degree the bigger prostate volume.

The bladder neck may be defined as the portion of that viscus which marks the junction of the bladder cavity with the urethral lumen. In a static phase this consists of the distal portion of the trigone and adjacent distal detrusor, actuallyapparent accumulations of smooth muscle bundles, some of which extend into the proximal urethra. The inherent tone of the smooth muscle augmented by abundant intermingled elastic tissue provides for urinary continence. Contraction of the smooth muscle of the detrusor results in shortening and widening of the proximal urethra to permit normal voiding [1,2]. Anomalous development of this area involves abnormalities in smooth muscle, connective and elastic tissue. Some of these abnormalities produce gross and severe organic obstruction to the bladder outlet, so that there is advanced damage to the urinary tract apparent at birth (Fig. 1). Varying degrees of obstruction or dysfunction results from others. These may become apparent only later in life when infection or signs and symptoms of renal failure supervene (Fig. 2).

Fifty years after surgical castration, an elderly man developed bladder outlet obstruction due to massive prostatic calculi. The composition of the calculi was characteristic of prostatic concretions which form in normal men. This case questions those theories which attribute prostatic calculi to precipitation of the salts contained in testosterone-stimulated prostatic secretions.

Two hundred and forty-eight children were evaluated to ascertain the cause of vesicoureteral reflux. Bladder outlet obstruction was corrected when present. Ureteral reimplantation was performed when infection persisted, hydronephrosis worsened, or renal clearances deteriorated. Except in patients with neurogenic bladder and exstrophy, reflux ceased, improved or stabilized in 81%, without operation. When reflux was due to infection or occurred through a normal ureterovesical junction behind an obstruction, reimplantation was unnecessary. Reflux due to a short intravesical ureter usually stopped while a completely gaping orifice often required surgical revision. The more abnormal the ureteral orifice appears, the more likely it is that antireflux surgery will be required. Deterioration of renal function was occurring in spite of therapy in some of the 19% of refluxing renal units requiring reimplantation. It is not possible to successfully manage all patients with reflux without operation.