Urinary bladder

Fungal Ball in the Urinary Bladder

Posted by

0


A 68-year-old man with type 2 diabetes presented to the emergency department with a 3-day history of dysuria, intermittent hematuria, and the passage of small balls in his urine with straining. He reported no fever, chills, or flank pain. Three months before presentation, he had started treatment with a sodium–glucose cotransporter 2 (SGLT2) inhibitor. The results of a physical examination were normal. A urine specimen contained a white ball measuring 1.5 cm in diameter (Panel A). Laboratory studies showed a glycated hemoglobin value of 7.8% (reference range, 4 to 6), and a urinalysis revealed glucosuria, pyuria, hematuria, and the presence of yeast. An ultrasound examination showed a 2-cm mobile mass on the bladder floor (Panel B). A urine culture grew Candida albicans, and a diagnosis of candida cystitis with fungal balls was made. Patients with type 2 diabetes are at increased risk for genitourinary infections, and SGLT2 inhibitors may further augment this risk by increasing the degree of glycosuria. This drug class has been more frequently associated with genital mycotic infections, such as candida vaginitis and balanitis, than with fungal urinary tract infections. Treatment with fluconazole was initiated, and the SGLT2 inhibitor therapy was discontinued. Cystoscopy was not performed. At the 4-week follow-up visit, the patient’s symptoms had abated.

Prosthetic bladder ‘controls urine’

Posted by

0


A device that could one day restore bladder function to patients with a severed spinal cord has been devised by UK researchers and tested in animals.

Nerve damage can leave no sense of when the bladder is full or control over when the contents are released.

A study, published in Science Translational Medicine, showed a device to read the remaining nerves’ signals could be used to control the organ.

The charity Spinal Research said this was “impressive and important” work.

The loss of bladder, bowel and sexual function after spinal cord injury is often rated by patients as having the biggest impact on quality of life.

Blocked signals

When the spinal cord is injured, signals passing up from the bladder cannot tell the brain when the bladder is full. Going the other way, signals from the brain cannot tell the bladder when it is time to go to the toilet.

Researchers at the University of Cambridge have devised a solution that uses the nerves still around the bladder.

Electrodes wrapped around bundles of nerves can interpret signals that say the bladder is full.

Continue reading the main story

“Start Quote

The ultimate aim is to regenerate the spinal cord, what we’re doing is restoring some function.”

Dr Daniel Chew Cambridge University

Stimulating other sets of nerves can get the bladder to contract on demand and prevent it emptying of its own volition.

One of the researchers, Dr Daniel Chew, told the BBC the device had worked on rats.

“It is very effective. The feasibility studies are done, we’re now limited by miniaturisation of the technology,” he said.

While the components that fit inside a rat could be converted for human use, the rest of the technology to process the information recorded currently needs a 6ft (2m) stack of equipment.

This needs to shrunk down to a handheld device that can inform a patient when the bladder is full and a trigger button to contract the bladder.

Bladder x-ray

Dr Chew added: “This device is not the ultimate goal, the ultimate aim is to regenerate the spinal cord. What we’re doing is restoring some function, not curing spinal cord injury.”

Dr Mark Bacon, the director of research at the charity Spinal Research, told the BBC: “Bladder dysfunction blights the life of many with spinal cord injuries and has a very major impact on their health and quality of life.

“This is impressive and important work addressing one of the major limitations found with existing options for electrical stimulation to control bladder emptying, namely the need to surgically destroy the sensory fibres coming from the bladder.

“Sparing and making use of sensory signals from a filling bladder adds a welcome degree of sophistication to elective voiding whilst retaining other functions normally lost such as erectile function – a distressing consequence of current methods.”

Seminal vesicle carcinoma.

Posted by

0


A 56-year-old man presented with a 29 day history of urgency and twice-hourly micturition. Physical examination was shown a cystic mass in the lower left abdomen. Intravenous urography showed right kidney hydronephrosis and hydroureter. CT scan of the pelvis showed a cystic mass behind the bladder, measuring 14·6 × 10·6 × 12·0 cm . Three-dimensional reconstruction of the pelvis showed a seminal vesicle adenocarcinoma (and the extruded and displaced bladder).

semvcyst

Prostate specifc antigen (PSA) before admission was 40·75 ng/mL. On admission, he was clinically stable, with serum PSA concentration of 28 ng/mL. Urine cytology examination measured three times was negative. Our presumptive diagnosis based on imaging results was a seminal vesicle diverticulum. No bladder tumours were found on cystoscopy and our patient had bilateral ureteral intubation and laparoscopic resection of the pelvic mass. Histopathological examination showed seminal vesicle papillary adenocarcinoma. Immunohistochemical staining was positive for CEA and CK7, negative for CA125, PSA and PsAP. Postoperative histologic examination confirmed the diagnosis of primary papillary adenocarcinoma of the seminal vesicle.

Source: Lancet

Emphysematous cystitis.

Posted by

0


A 55-year-old man with a history of aortic valve replacement was admitted because of pelvic pain. He had been treated with antibiotics over the past 4 weeks for a presumed lower urinary tract infection with fever. Treatment had been unsuccessful. Both urine and blood cultures grew Enterobacter cloacae. Abdominal radiography showed a thin line of air within the bladder wall, outlining its perimeter .A bacteraemic emphysematous cystitis complicated by prosthetic valve endocarditis was diagnosed, and effective antibiotic treatment was initiated.

PIIS0140673608614841.fx1.lrg

Emphysematous cystitis is a potentially life-threatening condition caused by gas-producing pathogens. This rare form of urinary tract infection typically occurs in middle-aged diabetic women. Contrary to radiological findings, clinical features are non-specific (irritative bladder symptoms, pyuria, haematuria, and, rarely, pneumaturia). Plain abdominal radiography, as well as ultrasonography, may lead to the diagnosis but CT scan is regarded as the procedure of choice, particularly to rule out a vesicocolic fistula. Early diagnosis and management consists of antibiotic therapy, bladder drainage, and sometimes surgery.

Source: Lancet