Obstrução do Trato Urinário Baixo Fetal / Fetal lower urinary tract obstruction

A obstrução do trato urinário baixo fetal (fetal lower urinary tract obstruction - LUTO) é uma patologia caracterizada por dilatação da bexiga e hidronefrose bilateral causada por obstrução do trato urinário inferior. Sua incidência é de 2,2 em cada 10.000 nascimentos. A etiologia da LUTO inclui a válvula da uretra posterior (VUP), atresia ou estenose uretral. O diagnóstico é feito por ultrassom, que mostra bexiga dilatada, com paredes espessas (megabexiga), e uretra posterior aumentada. O tratamento cirúrgico clássico (derivação vésico-amniótica guiada por ultrassom) estaria indicado quando o líquido amniótico normal começa a diminuir, com aumento da distensão vesical e da hidronefrose. O tratamento inclui a colocação de derivação vésico-amniótica guiado pelo ultrassom e fetoscópica com coagulação a laser. De acordo com a gravidade, a LUTO é classificada nos estágios 1,2 e 3.(AU)

The Fetal Lower Urinary Tract Obstruction (LUTO) is a spectrum of diseases characterized by bladder distension and bilateral hydronephrosis in consequence of the LUTO. The incidence is approximately 2.2 in 10,000 births and it is commonly diagnosed during the late first or early second trimester of pregnancy. The etiologies of LUTO include posterior urethral valves, urethral atresia and urethral stenosis. Complete bladder outlet obstruction (severe LUTO) is associated with high perinatal mortality due to pulmonary hypoplasia and severe renal impairment/damage. The prenatal intervention includes vesicoamniotic shunt placement guided by ultrasound and fetoscopic laser coagulation. It is suggested that LUTO patients could be categorized in three stages according to disease gravity: Stages 1, 2 and 3.(AU)

Differential diagnosis of the etiologies of fetal megacystis by prenatal ultrasonography / 中华超声影像学杂志

Objective To explore the clinical value of prenatal ultrasonography in the differentiation among the etiologies of fetal megacystis.Methods Twenty seven fetuses,diagnosed as fetal megacystis by prenatal ultrasonography,were retrospectively analyzed.The etiologies of fetal megacystis were presumed by such characteristics as keyhole sign,thickness of the bladder wall,amniotic fluid index,fetal sex and other combined signs.All fetuses were followed up until to the induction of labor or birth.Results Twenty seven singleton fetuses (19 males and 8 females) were diagnosed as megacystis.According to the characteristics and other combined signs,8 cases of posterior urethral valves (PUV),1 of prune belly syndrome(PBS),1 of megacystis-microcolon intestinal hypoperistalsis syndrome(MMIHS),1 of urethral atresia and 5 of chromosomal abnormality were presumed by prenatal ultrasound.Multiple malformations were found in 5 fetuses and there were also 6 fetuses with unknown reason originally.Among the 27 fetuses,21 were induced labor and 6 continued pregnancy to birth.Except for the 6 cases of unknown reason,etiologies of 17 fetuses with megacystis were confirmed by autopsy,genetic tests,surgery or further examination after birth.The accuracy rate of prenatal ultrasonography in the differentiation among the etiologies of fetal megacystis was 80.95％ (17/21).Conclusions On the basis of detailed prenatal ultrasonography and typical characteristics,it is reliable to differentiate the etiologies of fetal megacystis.Sometimes fetal megacystis may be one part of multiple malformations or complex syndrome,such as VACTERL syndrome.However,it is difficult for ultrasonography to diagnose vesicoureteral reflux(VUR)prenatally.

Progress of diagnosis and treatment of fetal and newborn lower urinary tract obstruction / 中华实用儿科临床杂志

Congenital lower urinary tract obstruction in the fetus and is rare in neonates,but it is identified in-creasingly in the era of prenatal sonography and resulted in substantial perinatal mortality with lifelong morbidity. Poste-rior urethral valves,urethral atresia,and prune - belly syndrome are the frequently reported causes of lower urinary tract obstruction. Despite the completion of a randomized trial,the benefit of prenatal intervention with vesicoamniotic shunt placement remains unclear. The management of these disease in fetus and newborns requires appropriate urinary tract decompression,subspecially support,and definitive diagnosis with endoscopy and radiography. Now,the recent progress of diagnosis and treatment of congenital lower urinary tract obstruction were reviewed.

The lower urinary tract obstruction of urodynamic study on young and middle-aged patients with chronic prostatitis / 中国医师进修杂志

Objective To study the urodynamic change of young and middle-aged patients with chronic prostatitis,and provide reference for clinical diagnosis and treatment.Methods Seventy young and middle-aged patients with chronic prostatitis were selected,the bladder capacity,bladder stability,bladder compliance,detrusor pressure and bladder pressure volume curve etc were measured.Results Unstable of detrusor contraction of 20 cases (28.6％,20/70),bladder sensitivity of 35 cases (50.0％,35/70),detrusor underactivity of 46 cases (65.7％,46/70).In 70 young and middle-aged patients with chronic prostatitis,the maximum bladder capacity was 100-497 (380 ± 80) ml,the detrusor pressure at maximum flow rate was 11.2-112.2 (38.4 ± 3.9) cm H2O (1 cm H2O =0.098 kPa),the drop of maximum flow rate was (10.53 ± 1.92) ml/s.Conclusions Through the urodynamic examination,the lower urinary tract obstruction syndrome can be found in young and middle-aged patients with chronic prostatitis,especially who have no significantly improvement after drug therapy.Now,the urodynamic examination for the lower urinary tract obstruction is a credible way to diagnosis,which plays an important role in diagnosis of chronic prostatitis and is useful for clinical practice.

Primary non-hodgkins lymphoma of the prostate: A rare case of lower urinary tract obstruction

Primary non-Hodgkins lymphoma of the prostate is extremely rare. Only twenty-two cases had been reported worldwide. No local report has been published, hence, we present the first documented case of primary non-Hodgkins lymphoma of the prostate in the Philippines. This was the case of a 68-year old male who was diagnosed and managed initially as Benign Prostatic Hyperplasia, however, the histopathological report turned out to be non-Hodgkins lymphoma of the prostate. Lymphoma of the prostate, whether primary or secondary is difficult to diagnose because of lack of distinct and characteristic signs and symptoms as well as absence of specific diagnostic examinations. Without adequate tissue for histology, it is difficult to arrive at the appropriate diagnosis preoperatively. At present, there are no large series and no existing standard treatment protocol for prostate lymphoma. Awareness of the disease entity is important in urologic practice in order to diagnose and manage it accordingly. (Author)