ABSTRACT
Systemic sclerosis is a rare and complex autoimmune disease, and malakoplakia is a rare chronic granulomatous inflammatory disease. Systemic sclerosis combined with malakoplakia is extremely rare. Diagnosis is difficult before surgery. It is easy to misdiagnose bladder malakoplakia as bladder tumor. This paper reports a middle-aged female patient with systemic sclerosis complicated with bladder malakoplakia. The main clinical manifestations were hematuria and bladder irritation, accompanied by severe diarrhea. Transurethral resection of bladder tumor was performed. Postoperative pathology proved that it was bladder malakoplakia. After the surgery, she continued to take low-dose prednisolone and methotrexate in the treatment of systemic sclerosis. The patient was followed up for 6 months.Transurethral cystoscopy was performed twice, and there was no recurrence.
ABSTRACT
ObjectiveTo evaluate the clinical efficacy of bladder hydrodistention and intravesical sodium hyaluronate in the treatment of interstitial cystitis (IC).Methods Twenty-one IC patients received intravesical sodium hyaluronate therapy under combined blockage or intravenous anesthesia.Bladders were perfused with normal saline under 100 cm H2O perfusion pressure and expanded for 10 min,the bladders were then injected through a catheter with 40 mg/50 ml sodium hyaluronate which was released after 1 h.Intravesical perfusion was applied once every week four to six times in a course of treatment.Results The average bladder capacity was extended from 191.6 ± 88.7 ml before expansion to 425.3 ± 79.8 ml after bladder expansion ( P =0.000).The extension was done under anesthesia.There were two suspected bladder ruptures after starting the bladder expansion at 6.5 min and 7.2 min.There was significant gross hematuria in 19 cases,10 min after bladder expansion.After treatment,the catheters were removed 24 h after manipulation in 17 patients; the catheters were removed 72 h after manipulation in two cases with hematuria;the catheters were removed four days after manipulation in the two cases of suspected bladder rupture.Pain was significantly reduced after the catheters were removed and the maximum urinary output increased slightly.The day before the second injection of sodium hyaluronate,the urinary frequency decreased significantly than before start of treatment (32.8 vs 18.5 times/24 h).The maximum urinary output increased significantly compared with the output before treatment (86.7 vs 151.9 ml).Pain was reduced significantly after treatment (8.7 vs 3.0).The O'Leary-Sant IC score and the QOL were significantly improved (30.0 vs 17.0,5.9 vs 2.4,respectively) (P =0.000).After the third treatment,the symptoms continued to improve.The treatment results were best in the fifth week at the time of the sixth injection of sodium hyaluronate.Symptoms rebounded at six months.However compared with that before treatment,the difference was still statistically significant ( P =0.000).ConclusionsBladder hydrodistention under anesthesia for severe intractable IC patients produces immediate effectiveness.Sodium hyaluronic infusion can alleviate urinary frequency and pain,and the effectiveness and duration of treatment are positively correlated.
ABSTRACT
Objective To evaluate the predictive effect of preoperative pressure-flow studies on the outcome of transurethral prostatectomy.Methods Sixty-three patients with benign prostatic hyperplasia(BPH) were evaluated by using pressure-flow studies,international prostate symptom score,uroflowmetry,and residual urine volume before and 3 months after surgery.The patients were divided into 3 groups(obstruction equivocal and unobstruction) according to the grade of pressure-flow.The outcome of transurethral prostatectomy were analyzed in each group with detrusor contractility(weak or normal).Results Treatment outcome could be predicted by using the grade of benign prostatic obstruction and detrusor contractility.The sensitivity of which was 73.5%,with a specificity of 88.5% and positive predictive value of 96.2%.Conclusions Urodynamic studies provide great predictive value of option in transurethral prostatectomy.