Sonographic correlations between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic hyperplasia in Ibadan, Nigeria

Evaluating bladder outlet obstruction (BOO) in patients with prostatic enlargement may reflect the severity of the disease and aid in predicting the treatment outcome. Objectives: To determine the sonological correlation between intravesical prostatic protrusion and bladder outlet obstruction in patients with symptomatic benign prostatic enlargement. Methods: This prospective study was conducted over one year at the Department of Radiology, University College Hospital, Ibadan. A transabdominal ultrasound scan of the urinary bladder and prostate gland was carried out on patients with prostatic enlargement and BOO. The intravesical prostatic protrusion, pre-and post-void urine volumes, prostate volume and bladder wall thickness were measured. Results: A total of 132 men aged 43 to 90 years (mean age: 63.8±8.64 years) were studied. The median size of the intravesical prostatic protrusion (IPP) was 7.25 mm (IQR: 0.00 mm; 14.9 mm). The mean prostate volume was 63.3ml±36.0ml. Most subjects (55; 41.7%) had a prostate volume above 60ml, and most patients (101, 77.2%) had bladder wall thickness less than 5mm. The mean bladder wall thickness was 4.26mm±1.54mm. There was a statistically significant correlation between IPP and pre-void urine volume and prostate volume (p = 0.002 and <0.001, respectively). Patients over 70 years had increasing IPP and post-void urine, which lacked statistical significance (p =0.15). Conclusion: The severity of bladder outlet obstruction was reflected in the pre-void urine volume, which correlated with the size of IPP

Menstrual hygiene management in public high schools in Ghana

in the ten (10) regions of Ghana. The findings showed that most girls in Public Senior High Schools in Ghana had prior knowledge about menstruation from their mothers and sisters prior to menarche. It was revealed that majority of the girls mentioned hormones as the cause of menstruation, whilst others mentioned the uterus, bladder, vagina, and other parts of the female reproductive system. A few of them had no idea what causes menstruation. The findings again revealed that most girls use sanitary pads, while some use other materials during menstruation. Less than half of the sample of girls in this study were able to change their pads twice daily or more. About half of the girls cleansed their genital parts only when bathing during menstruation using soup and water mostly. Half of the schools used public tap/standpipe as their main source of water and the rest used other sources of water. Also, most schools have toilet facilities. Some useful recommendations are proffered with the aim of improving MHM in public high schools in Ghana

Vesicovaginal fistula diagnosis and repair, Benghazi, Libya (nine years of of experience)

Introduction: Although most of vesicovaginal fistulas (VVF) are iatrogenic, they can also occur as a result of congenital anomalies, neoplastic changes, and complications of radiotherapy. In rural areas, the obstructed labor may lead to the development of VVF. However, the most common cause of VVF in developed areas is iatrogenic damage of the bladder tissue.Aim: To confirm that the immediate repair of iatrogenic urinary bladder injures during obstetric or gynecological surgeries prevents VVF formation, and to identify optimal time and outcome of surgical techniques of VVF repair.Patients & Methods: Prospective study was carried over 9 years and included 95 patients. These patients were divided into two groups; one group underwent immediate intra-operative repair of urinary bladder injuries (n=76), while other group presented with VVF and underwent either reconstructive or urinary diversion surgeries on elective bases (n=19).Results: The mean age of 19 cases having VVF was 29.4 ± 8.4 years. One case was missed and other 18 cases underwent abdominal repair (n=8), vaginal repair (n=5) and permanent urinary diversion (n=5). The time of repair ranged from 2 day to 7 months after detection of VVF. The success rate of post-surgical VVF repair was 92.3%.Conclusion: Immediate repair of urinary bladder injuries during obstetric or gynecological surgeries prevents development of VVF. Post-surgical VVF repair can be done in first post-operative days before inflammatory changes takes place. The result of VVF repair depends on the experience of the surgeon rather than the used surgical techniques

"Gunshot injury to the pelvis".The bullet voided through the urethra

Gunshot injuries (GSIs) are considered as an emergency and life threatening. The gunshots injuries to the urinary tract are uncommon. The high-velocity of bullet can cause both a penetrating injury to the target organs as well as blast injury to nearby structures, in addition to thermal injuries. In most of the cases, laparotomy is required to remove the bullet and to repair the injuries. The phenomenon of spontaneous migration of retained bullet to different parts of body has been described in the medical literature. Here, we present a patient who sustained penetrating GSI to the pelvis, without organ injuries, including the bladder. The bullet initially was retained within peri-vesical fat and the bladder wall while the mucosa remained intact, then it migrated into the bladder and came out through the urethra during voiding on the sixth day after injury

Predicting the Fragility of Renal Calculi in Response to Shock Wave Lithotripsy through their Radiographic Appearance

Objectives To evaluate the radiological characteristics of renal stones on plain X-ray film of the kidneys; ureters and bladder (KUB) area as predictors of stone fragility during shock wave lithotripsy (SWL). Patients and Methods This prospective study included 336 patients who had a single renal pelvic stone =20 mm and were managed by SWL at 3 different centers. The patients were classified according to the radiological appearance of the stone on KUB film in terms of homogeneity; smoothness of the outline; and radiodensity in comparison to the last rib. The primary endpoint was the stone-free rate (SFR) within 3 months post-SWL. Multivariate regression analysis was used to compare the results. Results The overall SFR was 71.43. SFR was significantly higher in heterogeneous compared with homogenous stones (86vs. 53; p0.01) and in rough compared with smooth surface calculi (77vs. 61; p0.01). SFRs for stones with density less than; similar to or higher than that of the last rib were 82; 69and 56; respectively (p0.01). Multivariate analysis showed a positive proportional relationship between stone fragility (SWL outcome) and one or more favorable radiological criteria. Conclusion The radiological characteristics of renal calculi could predict their fragility after SWL. Stones which were heterogeneous; rough; or less dense than the last rib on KUB film were more likely to disintegrate during SWL

Pseudotumoral malacoplakia of the bladder

Malacoplakia is a rare inflammatory condition most often affecting the genitourinary system. We report the case of a 24-year-old man who presented with gross hematuria; nocturia; frequency; dysuria and considerable weight loss during the preceding three months. Digital rectal examination showed a solid pelvic mass. Ultrasonography and computed tomography showed calyceal dilatation on the right side and a solid bladder mass 10 cm in diameter suspicious of bladder cancer. Transurethral resection of the tumor was incomplete; due to the large volume of the bladder mass. Histological examination of the resected specimen revealed malacoplakia of the bladder. The patient was treated with fluoroquinolone and vitamin C. Follow-up at 3 months showed marked regression of the bladder mass and complete resolution of the calyceal dilatation

Pathologic Pattern of Invasive Bladder Carcinoma: Impact of Bilharziasis

Objective: To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Patients and Methods: Between April 2002 and October 2006; 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department; Cairo; Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type; stage; grade and gross features in addition to lymph node involvement were particularly noted. Results: Bilharzial bladder pathology (lesions or ova) was present in 105 (70.9) of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma (TCC) in 84 (56.7); squamous cell carcinoma (SCC) in 51 (34.5); adenocarcinoma in 9 (6.1) and anaplastic tumor in 4 (2.7) of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23; pT3 in 70.9and pT4a involving the prostate or seminal vesicles in 6.1. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 (48.6) and high grade in 76 (51.4) specimens. Regional lymph node involvement was detected in 31 (20.9) specimens irrespective of bilharzial infestation. Conclusion: Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3; low-grade SCC and commonly appears as an ulcerative; bulky; fungating or verrucous mass. On the other hand; bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation

Rupture vesicale du post partum; a propos d'un cas

La rupture secondaire vesicale intra peritoneal du post partum est rare. Nous rapportons une observation inhabituelle chez une femme de 25 ans qui etait adressee pour douleur abdominale aigue. Cinq jours auparavant; elle presentait un accouchement dystocique d'une grossesse menee a terme. Elle presentait une occlusion intestinale aigue du grele mecanique. L'abord median sus et sous ombilical permettait d'objectiver une rupture vesicale intra peritoneale et de traiter la lesion par suture en deux plans sous couvert d'une sonde uretro vesicale. La lesion vesicale etait parvenue au cours d'un accouchement dystocique sur vessie pleine. Une verification systematique du bas appareil urinaire apres toute intervention obstetricale laborieuse permet d'evoquer le diagnostic

Hematurie revelatrice d'une endometriose vesicale. A propos d'un cas

La localisation vesicale de l'endometriose est rare. Les auteurs en rapportent une observation chez une femme de 46 ans prise en charge au Centre Hospitalier Universitaire d'Antananarivo (Madagascar). Depuis six mois; elle presentait des douleurs pelviennes; une dysurie et une hematurie macroscopique concomitants aux menstrues. Une masse arrondie de 40;2mm localisee au niveau de la face posterieure de la vessie etait palpable au toucher vaginal et visible a l'echographie. Les arguments cliniques et echogra-phiques avaient fait suspecter une endometriose vesicale et un traitement chirurgical d'emblee etait pratique. Les differents aspects etiopathogeniques; cliniques et therapeu-tiques sont discutes a la lumiere d'une revue de la litterature

Electrohydraulic Versus Holmium Laser Lithotripsy for Bladder and Urethral Stones in Children

Objective: To compare the efficacy and safety of electrohydraulic and Holmium laser lithotripsy in the treatment of bladder and/or urethral stones in children. Materials and Methods: Between January 2000 and January 2006; 112 children (102 boys and 10 girls) aged between 2 and 13 years presented to our department with vesical (n=72) and urethral (n=40) stones. Previous surgery for bladder stones was reported in 28/112 (25) cases. The stone burden ranged from 4-22 mm. The stones were radiolucent in 12 (10.7) cases. Multiple bladder and combined urethral and vesical stones were recorded in 14 (12.5) cases. The children were divided into two groups according to the treatment modality: 50 children (Group A) were treated by electrohydraulic lithotripsy (EHL) using either pediatric cystoscopes or the short ureteroscope; 7 F; while in 62 children (Group B) Holmium laser was used through a 7.5 F pediatric endoscope without any modification. Follow up range was 1-1.5 years. Results: In Group A; disintegration was successful in 48/50 (96) cases. The mean operative time was 18.3 minutes. The urethral catheter was maintained for 24-72 hours (mean 36 hours). Conversion into open surgery was necessary in two cases. No other major operative or postoperative complications were encountered. In Group B; complete disintegration was achieved in all cases including impacted urethral stones. The mean operative time was 15.7 minutes. The urethral catheter was left for one day only in 36 (58.1) cases. Conclusion: In our series; Holmium laser lithotripsy used for the treatment of bladder or urethral stones in children caused no complications and achieved slightly better results than electrohydraulic lithotripsy. Nevertheless; electrohydraulic lithotripsy remains an effective and a viable option despite its rare - yet sometimes serious - complications

Radical Cystectomy for Locally Advanced Carcinoma of the Bladder in Kano; Nigeria

Objective: Bladder cancer is the second most common genito-urinary malignancy worldwide. The objective of this study was to assess the benefit of radical cystectomy on locally advanced bladder carcinoma in terms of improved quality of life and survival in our environment. Patients and Methods : The records of 58 patients with bladder carcinoma managed at Aminu Kano Teaching Hospital over a 5-year period (May 2000 to April 2005) were reviewed and analysed. Excluded were 28 patients with distant metastatic disease discovered during clinical investigation. Results: Thirty patients (25 males and 5 females) with a mean age of 50.5 years and variable symptoms underwent radical cystectomy for locally advanced carcinoma of the bladder. Urinary drainage was achieved by orthotopic ileal neobladder in 15 patients (50); continent cutaneous reservoir in 11 patients (36.7) and non-continent drainage in 4 patients (13.3). A 40survival was achieved at 6-60 months. Conclusion : Radical cystectomy is a worthwhile procedure in locally advanced carcinoma of the bladder and cure may be achieved in selected patients

Carcinoma of Urinary Bladder in a Region of Low Schistosomiasis

Aim: To study the geographical pathology of carcinoma of the urinary bladder as regards both its association with endemic schistosomiasis and the variable proportions of its histological types. Methods: A 30-year retrospective analysis was carried out with regard to Igbo patients who inhabit a region of low incidence of schistosomiasis with special reference to the occurrence of urinary carcinoma. Results: Carcinomas manifested in bladder biopsies from 24 patients and in cystectomy specimens from 12 patients. One case alone was associated with schistosomiasis. Conclusion: This lone case is a finding which is in consonance with the theory that the intensity of parasitic infestation is a significant factor in carcinogenesis

The Impact of preservation of the prostatic apex on the urodynamic characteristics in different orthotopic ileal reservoirs

Objective This study was carried out to evaluate the urodynamic characteristics of the Camey II; Kock's and W-configured ileal reservoirs utilized for orthotopic urinary diversion. Patients and Methods Between January 2000 and 2002; 42 male patients prospectively underwent radical cystoprostatectomy for bladder cancer followed by orthotopic urinary diversion at the urology department of Cairo University hospitals. All cases were evaluated clinically; bacteriologically; radiologically and urodynamically including uroflowmetry; medium-fill and voiding enterocystometry and urethral pressure profilometry; which was done in the early and late postoperative period (at 3-6 months and 6-18 months). Patients were divided into four groups: Group I: 11 cases with preservation of the prostatic apex and creation of a W-neobladder. Group II: 11 cases without prostatic apex preservation and creation of a W-shaped ileal pouch. Group III: 12 cases without prostatic apex preservation and creation of a Camey II pouch. Group IV: 8 cases without prostatic apex preservation and creation of a Kock's pouch. Results The patients of Group I had a larger mean neobladder capacity (699 ml) and volume at which the first contraction occurred (315 ml) and a larger amount of residual urine (224 ml) as compared to Group II (511.1; 285 and 77.5 ml; respectively); Group III (375; 200 and 55 ml; respectively) and Group IV (563; 266 and 600 ml; respectively). Also Group I with a preserved prostatic apex had a higher mean intraluminal opening pressure (55 cm H2O) and a higher pressure at maximum flow (62.36 cm H20) as compared to the patients with complete prostatic resection. Conclusion We conclude that the patients with a preserved prostatic apex (Group I) had a statistically significant higher mean residual urine in the early and late postoperative period and a significantly higher mean maximum cystometric capacity in the late postoperative period as compared to those recorded in patients with complete prostatic resection (Groups II; III; IV). A higher incidence of upper tract deterioration was detected in Group I (35) vs. 4.6; 27.8and 12.5in Groups II; III and IV; respectively

Endoscopic transurethral resection of bilharzial ulcers in the urinary bladder. Single-center experience with 1000 patients

Objective To report on the results of endoscopic transurethral resection of chonic bilharzial ulcers of the urinary bladder at the Assiut University Hospital; Assiut; Egypt. Patients and Methods Between June 1995 and April 2001; 1000 patients (87.3males and 12.7females) with chronic bilharzial ulcers (78de novo and 22recurrent ulcers after previous open partial cystectomy) were treated by endoscopic transurethral electroresection (TUR) at our department. Single ulcers were diagnosed in 612 (61.2); double ulcers in 261 (26.1) and multiple ulcers in 127 (12.7) patients. Ulcers of a moderate diameter (1-2 cm) were present in 505 (50.5) patients. Electroresection was done until healthy fibers of the detrusor muscle or even the prevesical fat was reached. Results The mean duration of the resection was 19.8 minutes. Extraperitoneal bladder perforation was recorded in 11 patients (1.1). In all these patients conservation was successful. Intraperitoneal bladder perforation was recorded in 16 patients (1.6). In six out of these patients conservation was successful; while peritoneal drainage was necessary in the remaining cases. Conservative management was successful in 5 cases (0.5) of secondary haemorrhage. Hospitalization was one day in 920 patients (92). After six months 862 patients (86.2) were available for follow up. 745 (86.4) were symptom-free and 794 (92.1) reported complete healing of the resected ulcer at follow-up cystoscopy. Conclusion Endoscopic transurethral electroresection is a satisfactory modality for the treatment of bilharzial ulcers of the urinary bladder