Genitourinary tract changes in neglected patients with myelomeningocoele

The objective of this paper was to describe the bladder and sphincter urodynamic profiles and the upper tract status of patients with myelomeningocoele. This was correlated with the patients age when initially evaluated. Patients from the Spina Bifida Support Group of the Philippines who underwent initial videourodynamics when first seen were included in the study. The procedure was performed using a Laborie Avanti 4.1 model urodynamic machine. The hostile profile included bladder-sphincter dyssynergia, dyssynergic bladder neck/sphincter or leak point pressure greater than 35 cm H2O. The non-hostile picture included areflexic bladder and sphincter, open or areflexic sphincter or leak point pressure less than 35 cm H2O. The upper tracts were also assessed for the presence of hydronephrosis or vesicoureteral reflux There were 83 myelomeningocoele patients who underwent screening videourodynamics. Their ages ranged from 2 months to 19 years. Fifty one patients presented with hostile bladder sphincter profile while 32 patients presented with non-hostile features. Among the patients with hostile features, 37 manifested with hydronephrosis and/or vesicoureteral reflux. Three patients already presented with renal failure. Beyond 2 years old, 34 patients showed hostile bladder sphincter profile. Sixteen patients already presented with hydronephrosis and/or reflux after the age of 5 years. Renal failure was manifested by older children, all exhibited hostile bladder sphincter features and upper tract deterioration. These data showed a positive correlation of age, hostile profile and upper tract changes in patients with myelomengocoele

Loss of vision: An unusual manifestation of prostate carcinoma

This is a case of a 69-year old male who presented with gradual loss of vision and protrusion of the right eye because of metastatic prostate carcinoma. Radiologic studies (CT scan and bone scan), PSA and prostate biopsy confirmed the diagnosis. Symptoms were abated after bilateral orchiectomy. Although considered to be unusual, orbital metastasis with its consequent eye involvement can be the presenting symptom of an elderly male with prostate cancer. (Author)

Retroperitoneal laparoscopic adrenalectomy: A documentation of the first case in the country

The initial experience in laparoscopic adrenalectomy has been performed transperitoneally. To further minimize the invasiveness, the concept of retroperitoneal laparoscopy was developed and is rapidly gaining grounds as the standard of care. Locally, surgeons have been reluctant in adopting this remarkable alternative due to lack of facilities, experience and support. Thus, only 4 cases of laparoscopic adrenalectomies, all via the transperitoneal approach, had been performed for the past 4 years. Considering the limited experience, inadequate facilities and instruments, still, it was successfully performed with some procedural innovations and technical modifications. It follows the principles of minimally invasive surgery that can avoid some of the physiologic and technical complications of transperitoneal laparoscopic adrenalectomy in the country. It proves the possibility of the procedure in the local setting. As an innovative addition to urological practice, retroperitoneal laparoscopic adrenalectomy can therefore serve as an alternative treatment procedure for benign adrenal pathologies. (Author)

The value of a voiding cystourethrogram: Single and isolated recurrent urinary tract infection

OBJECTIVE: This study is designed to determine the correlation between a voiding cystourethrogram in children and a single and isolated recurrent urinary tract infection, as well as the most frequent presenting symptom in children yielding a positive resultMATERIALS AND METHODS: One hundred ninety seven (197) children, ages 0-6 years old, diagnosed to have a urinary tract infection based on history, physical examination, urinalysis and urine culture. Group I included those with single and isolated urinary tract infection: Group II, those with recurrent urinary tract infection. All patients in both groups underwent a voiding cystourethrogramRESULTS: Of one hundred ninety-seven (197), sixty-seven (67) of them were assigned to Group I, while one hundred thirty (130) were assigned to Group II. Sixteen (16) out of sixty-seven (67) in Group I (23 percent) and forty-four (44) out of one hundred thirty (130) in Group 2 had a positive VCUG. High grade fever was the most common presenting symptomCONCLUSION: The frequency of a urinary tract infection did not significantly affect positivity with voiding cystourethrogram. However, the presence of high grade fever correlated better with a (+) VCUG. (Author)

Tubularized tunica vaginalis graft for male urethral reconstruction

Graft substances such as skin, bladder and buccal mucosa have been used for urethral replacement when local epithelial tissue is not available. However, these subtances have been associated with meatal prolapse, stricture and fistula formation. We tried tunica vaginalis as a urethral graft in rabbitsA graft of tunica vaginalis was placed in the excised portion of the urethra in five experimental rabbits. After 6 weeks retrograde urethrograms revealed no strictures and a fistula formation in one rabbit. The histopathologic examination revealed that the tunica vaginalis was covered by the transitional epithelium of the urethra. The tunica vaginalis could be used as a urethral graft in animals with a fistula formation as a complication. (Author)