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In a retrospective study of 90 cases that had both abdominal ultrasound examinations of the bladder and cystoscopy, four cases of proven cystitis were identified. The sonographic appearance of cystitis is varied, depending on the severity of the process, and several manifestations of involvement detectable by ultrasonography are outlined.
BACKGROUND: Enterovesical fistula is a rare cause of recurrent urinary tract infections. This condition is unusual in young people as common etiologies include diverticular disease and cancer. When an enterovesical fistula occurs in women of childbearing age, Crohn's disease is a likely cause. To our knowledge, enterovesical fistula complicating pregnancy has not been reported before. CASE: A pregnant woman with recurrent urinary tract infections was evaluated. Cystoscopy was suggestive of an enterovesical fistula, which was confirmed by charcoaluria following oral charcoal administration. The prenatal course was complicated by two episodes of hemorrhagic cystitis despite antibiotic prophylaxis. The patient had an uncomplicated term spontaneous vaginal delivery. An upper gastrointestinal series performed postpartum was suggestive of Crohn's disease and confirmed an enterovesical fistula. Surgical repair was successfully performed three months following delivery, revealing Crohn's disease. CONCLUSION: Enterovesical fistula may be an unusual cause of recurrent urinary tract infections in pregnancy. In this case, enterovesical fistula was the presenting symptom of Crohn's disease.
Posterior urethral polyps are rare. A case is reported in a 7-year-old boy presenting with pain and burning micturition. Ultrasound and cystography revealed the diagnosis by showing a round solid structure in the bladder neck. Cystoscopy confirmed the diagnosis by showing its implantation base at the summit of the verumontanum. The polyp was removed by endoscopic resection and histological examination of the resection specimen showed a fibrous polyp. A brief review of the clinical features, diagnostic methods, natural history and treatment of this benign tumour is presented.
The value of the BARD bladder tumour antigen (BTA) test for the diagnosis of bladder tumour was compared to urinary cytology. A total of 60 patients with bladder tumours (Category Ta: 39 patients and Category T1-4: 21 patients) were investigated. Urinary cytology was found to be more sensitive than the BTA test. The overall sensitivity of cytology was 0.63 compared to 0.27 for the BTA test. The sensitivity of both tests improved with increasing tumour severity. For Ta tumours and T1-4 tumours the sensitivity of cytology was 0.46 and 0.95 respectively, and for the BTA test it was 0.13 and 0.53 respectively. We conclude that urinary cytology is superior to the BTA test. The BTA test cannot be recommended either for bladder tumour screening or monitoring for recurrence because of too many false negative results. Because of its high specificity (0.93), a positive BTA test might reduce the number of flexible cystoscopies, and prepare the patient directly for tumour resection.
Mandatory examination: physical exam including, digital rectal examination; renal and bladder ultrasound and/or IVP, cystoscopy with full description of the lesion and with a diagram, urinalysis, urinary cytology; TUR with biopsy of the tumor base, biopsy of all suspicious areas; randomised biopsies in presence of positive cytology, tumor > 3 cm or non papillary tumour; biopsy of the prostatic urethra in cis or when there is suspicion of cis. When the tumor is invasive, it is mandatory to perform chest X-ray, IVP, and or abdominal and pelvic CT scan, liver ultrasound and bone scan, if there are symptoms or a high alkaline phosphatase.
The objective of this study was to determine the efficacy of ultrasonography and urography in evaluating patients presenting with painless gross haematuria for urinary malignancies. From October 1992 to March 1997, 468 consecutive patients presenting with painless gross haematureia were prospectively investigated. Ultrasonography and urography were performed independently, followed by diagnostic cystoscopy and other relevant investigations. One hundred and twenty-five urinary malignancies (26.7%) were detected in 122 patients, 85 being carcinoma of bladder (85/468 patients; 18.2%), followed by renal cell carcinoma (25/468 patients; 5.3%). Ultrasonography was significantly more sensitive (83/85; 98%) in the detection of bladder tumours, compared to urography (42/78; 54%) (P < 0.05). In the upper tract, there was no significant difference in the sensitivity of lesion detection. Ultrasonography is more sensitive than urography for diagnosing urological malignancies in patients presenting with painless gross haematuria, where carcinoma of bladder is the commonest pathology. Its utilisation as an initial screening investigation is recommended. Patients diagnosed to be suffering from carcinoma of bladder by ultrasonography should be scheduled directly and promptly for therapeutic endoscopy.
We report a rare case of recurrent chyluria in a 64-year-old man, who had undergone sclerosing therapy for chyluria with complete remission 40 years previously. The chyluria recurred 4 months before the present hospital admission. The patient presented with acute urine retention and weight loss of 6 kg during the past 6 months. Urine biochemistry studies showed elevated concentrations of albumin (0.7 g/dL), globulin (0.6 g/dL), cholesterol (0.59 mmol/L), and triglyceride (0.89 mmol/L), confirming the diagnosis of chyluria. Intravenous urography showed a substantial filling defect in the urinary bladder. Cystoscopy revealed milky urine flowing out of the right ureteral orifice, and a large chylous coagulum presenting as a cyst-like mass in the urinary bladder. The chyluria was successfully treated with sclerosing therapy with injection of 76% Urografin (Shering AG, Berlin, Germany) into the right upper urinary tract, and the chylous coagulum was evacuated endoscopically. No evidence of chyluria recurrence has been noted during a year of follow-up, and the patient has regained 6 kg of body weight. This particular presentation of chylous coagulum in a chyluria patient has not been previously reported in the literature.
BACKGROUND: The bladder tumour antigen (BTA) test has been found to be more sensitive than urine cytology for the detection of recurrent bladder cancer. We chose to evaluate the role of the bladder tumour antigen test in the management of gross haematuria on initial presentation. METHODS: A prospective analysis over a 3-month period of consecutive cases of gross haematuria was conducted. Routine investigations including intravenous urogram, flexible cystoscopy, urine cytology testing and BTA testing were performed. Results were correlated with the final diagnosis, and also with histology and tumour stage in the cases of malignant outcome. RESULTS: The prevalence of malignancy in our series was 25.5%. Sensitivity of the BTA test was 67% and specificity 66%. This was compared to cytology which yielded a sensitivity of 66% and specificity of 100%. There were 12 cases of falsely positive results on BTA testing, giving a positive predictive value of 40%. Four cases of falsely negative results were all from superficial tumours. CONCLUSION: In view of its poor sensitivity and positive predictive value, the BTA test has a limited role in the initial management of gross haematuria.
To evaluate the efficacy and safety of pentosan polysulfate sodium (PPS) in relieving symptoms of interstitial cystitis, the authors retrospectively reviewed charts of 260 patients in whom interstitial cystitis had been diagnosed. Subsequently, they conducted a follow-up phone interview or mail survey of those patients who were treated with PPS to investigate changes in the patients' symptoms, adverse effects, and change in quality of life. The control group consisted of patients whose interstitial cystitis had been diagnosed at cystoscopy and had a duration of at least 1 year and who had taken at least one or more oral medications for their symptoms. The average length of treatment was 9.3 months among the 27 subjects on PPS therapy. The mean length of time that they had diagnosed interstitial cystitis was 35.63 months and 48.78 months for the PPS-treated and control groups, respectively, with no statistically significant difference. Changes in frequency, urgency, and pain were greater in the treatment group and statistically significant (P = .11, P = .49, and P = .004, respectively). No change occurred in the rate of nocturia in the PPS-treated group compared with that in the control group. Symptoms of both groups improved over time, but improvement was statistically significantly greater in the treatment group (P = .001) over the treatment interval. The most common side effect attributable to PPS was diarrhea in 15% of subjects. Pentosan proved to be an efficacious option for reducing the debilitating symptoms of interstitial cystitis.
The aim of our study is to evaluate the diagnostic and therapeutic attitude toward endometriosis of the bladder. We have analysed four observations treated in the gynecologic service of Hotel-Dieu in Paris between January 1989 and January 1998, which represents 1.3% of all endometriosis operated during this period. Every patient underwent echography, RMN, UIV and cystoscopy. In all for cases a surgical treatment by laparotomy was realised. The choice of this way is explained by the multiple localisations of endometriosis in three cases and the impossibility of a coelioscopic treatment in the forth. The anatomopathologic exam found endometriosis in all of the cases.
Leiomyoma of the female urethra is a rare condition. It is a benign mesenchymal tumor that commonly presents with recurrent urinary tract infections and various lower urinary tract symptoms. We report a case of urethral leiomyoma and review the literature. A 44-year-old woman presented with severe irritative voiding symptoms without urinary tract infection and bilateral upper urinary tract dilation. Ultrasound and cystoscopy revealed a smooth mass arising from the urethra and projecting into the bladder. Transurethral resection of the mass was performed and 32 g of tissue was removed. There were no complications and the symptoms resolved completely, indicating this to be a safe approach. Histopathology showed the tumor to be leiomyoma.
We report a case of bladder hemangioma manifesting bladder tamponade during pregnancy. A 25-year-old woman at 36 weeks of gestation was admitted with a two-week history of gross hematuria and clot retention. Blood hemoglobin concentration was 6.3 g/dl. After blood transfusion and Caesarian section, cystoscopy was performed. Bleeding was noticed from a strawberry-like tumor 5 mm in diameter near the right ureteral orifice, which was easily resected endoscopically. Histopathological diagnosis was cavernous hemangioma of the urinary bladder. This is the first report of a case of bladder hemangioma during pregnancy.
Alterations at microsatellite DNA markers in cells exfoliated in urine have been correlated to the presence of bladder cancer. To check the feasibility of such noninvasive analysis to routinely diagnose bladder cancers, we have developed a highly sensitive method using fluorescent PCR to search for DNA microsatellite alterations in urine sediment compared with a blood paired sample. One hundred eighty-three patients were included in our study. This population comprised 103 bladder cancers (64 pTa stages), the complement representing controls and other benign or malignant diseases. Results of the analysis at 17 loci in a blinded study were compared with cystoscopy and/or pathology. The high reproducibility of this technique and the analysis of 26 control patients allowed us to determine for each microsatellite a cutoff characterizing a significant allelic imbalance. For bladder cancer detection, the overall sensitivity of the test was 84%. Using this procedure, we identified alterations in 81%, 84%, 91%, and 100% of pTa, pT1, pT2, and >pT2 stages, respectively. This corresponds to 79%, 82%, and 96% sensitivity for grades I, II, and III, respectively. Interestingly, for routine purposes, we observed an overall sensitivity of 80% (76% for pTa stages) when only the eight most rearranged microsatellites were considered. In conclusion, the noninvasive feature combined with the rapidity of this fluorescent and highly sensitive technique for the detection of early stages provides us with a useful help for the diagnosis of bladder cancer.
Vesical varices in portal hypertension are rare. We report a patient with portal hypertension who developed recurrent painless hematuria. Cystoscopy was normal. Doppler ultrasound and MR angiography showed a dilated paraumbilical vein within the falciform ligament coursing down to the urinary bladder wall and draining into the right internal iliac vein. He underwent liver transplantation for decompensated chronic liver disease. He is in good health and has not had further episodes of hematuria.
PURPOSE: Although the exact etiology of interstitial cystitis remains elusive, bladder inflammation appears to be common in many patients. The National Institutes of Health (NIH) have established diagnostic criteria for interstitial cystitis based on the presence of irritative voiding symptoms in the absence of other identifiable pathology. Cystoscopic examination with hydrodistention performed in patients under anesthesia is part of the NIH diagnostic criteria. We determine if the severity of cystoscopic findings correlated with histological evidence of inflammation in patients with suspected interstitial cystitis. MATERIALS AND METHODS: A total of 69 patients who met NIH symptom criteria for interstitial cystitis and underwent cystoscopy, hydrodistention and bladder biopsy under anesthesia were reviewed. There were 2 investigators blinded to the histological data who independently reviewed operative reports. A urological pathologist blinded to the clinical data reviewed biopsies for inflammation severity. Cystoscopic and histological findings were then converted to a numeric scale. Numeric data were analyzed using the Pearson correlation coefficient. RESULTS: Cystoscopic examination revealed no evidence of interstitial cystitis in 6 patients (9%), mild changes in 27 (39%), moderate changes in 23 (33%) and severe changes in 13 (19%). Histological examination revealed no inflammation in 21 patients (30%), mild inflammation in 28 (41%), moderate inflammation in 11 (16%) and severe inflammation in 9 (13%). Histological scores correlated poorly with total and scaled cystoscopic severity scores (r = 0.295 and 0.349, respectively). CONCLUSIONS: Severity of cystoscopic findings observed during hydrodistention with anesthesia does not appear to correlate with the degree of inflammation identified histologically in patients with suspected interstitial cystitis.
PURPOSE: We reviewed currently available bladder cancer tests in the context of the clinical expectations of a noninvasive bladder cancer test. MATERIALS AND METHODS: We reviewed the literature on bladder cancer tests that are commercially available or have shown clinical usefulness and examined how each test compares with standard methods of bladder cancer diagnosis. RESULTS: The clinical necessity for a noninvasive test for bladder cancer is 2-fold, including the early detection of high grade bladder tumors before muscle invasion and monitoring tumor recurrence or new onset. An ideal noninvasive test should be sensitive, specific, rapid, technically simple and have low intra-assay and interassay variability. Urine cytology has high specificity but limited applicability due to its relatively low sensitivity and subjective nature. Hematuria detection by Hemastix dipstick is sensitive but not specific for detecting bladder cancer. Molecules associated with bladder tumor growth and progression may serve as a basis for designing noninvasive diagnostic tests. The Food and Drug Administration approved BTA Stat and BTA TRAK tests, which detect human complement factor H and a related protein in urine, have 60% to 80% sensitivity and 50% to 70% specificity (lower in symptomatic patients) for bladder cancer. The Food and Drug Administration approved NMP22 test, which measures the level of nuclear mitotic apparatus protein in urine, has 50% to 100% sensitivity and 60% to 90% specificity. Accu-Dx detects fibrin degradation products, fibrin and fibrinogen in urine, although this test is no longer commercially available. The Immunocyt test combines cytology with an immunofluorescence technique to improve the sensitivity of cytology for detecting low grade tumors. The telomeric repeat amplification protocol assay for telomerase in exfoliated cells has 70% to 86% sensitivity and 60% to 90% specificity for bladder cancer. However, the low stability of telomerase in urine affects its sensitivity. The hyaluronic acid and hyaluronidase (HA-HAase) test, which measures the urinary level of hyaluronic acid and hyaluronidase, has 90% to 92% sensitivity and 80% to 84% specificity for bladder cancer. Quanticyt karyometry evaluates nuclear shape and DNA content of exfoliated cells to detect bladder cancer. The list of bladder tumor markers is growing rapidly and large multicenter trials are essential to assess their usefulness. CONCLUSIONS: Although currently noninvasive bladder cancer tests cannot replace cystoscopy, some have shown a promise of being clinically useful. One or a combination of these tests-markers may prove to be a prostate specific antigen for bladder cancer provided that patients and, more importantly, clinicians accept it.
The Latzko operation for the closure of a vesico-vaginal fistula is still not well enough known. Urologists have voiced doubts about the functional quality of the late results after this operation. Pouches in the bladder wall which could lead to infection and stone formation are said to occur frequently. Follow-up studies regarding this question are not known. Therefore the patients treated at the University Hospitals Erlangen-Nuernberg and Graz between 1962 and 1972 were subjected to a standardized follow-up protocol. Of 37 women who had the Latzko operation, 24 women returned for a follow-up examination. 19 women had no intermittent urinary tract disease and the follow-up results were normal. In many instances a scar corresponding to the previous fistula could not be detected on cystoscopy. Immediately after the operation, one patient had a recurrent fistula and has not been re-operated. Four women had significant urinary tract findings or had intermittent urinary tract disease. These complications were possibly due to the operation in one case and likely due to the operation in a second case. Our findings suggests that the Latzko operation is the method of choice for the treatment of the typical post-hysterectomy vesico-vaginal fistula.
The case of a 49 year-old female patient, with frequency of urination for 2 years, having a mass at the anterior bladder wall and at the anterior abdominal wall is reported. Cystoscopy found an impression of the anterior bladder wall and hyperremic edematous bladder mucosa. Pre-operative computerized tomography suspected bladder tumor. Laparotomy revealed an inflammatory firm mass at the anterior bladder wall and another mass at the anterior abdominal wall. Partial cystectomy and excision of the mass at the anterior abdominal wall were performed. After the pathological examination confirmed actinomycosis, the patient was treated post operatively with penicillin. She recovered well.