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Resumen ANTECEDENTES: El síndrome de Fowler es poco común, con predominio en mujeres jóvenes; se caracteriza por una actividad anormal, con contracciones repetidas en el esfínter uretral externo, en ausencia de enfermedad neurológica. CASO CLÍNICO: Paciente de 51 años, acudió a consulta por prolapso de órganos pélvicos con sensación de masa en la vagina y dificultad para orinar. En la videourodinamia se apreció una onda intermitente, con hipoactividad del detrusor y micción no coordinada, sin incontinencia, hallazgos característicos del síndrome de Fowler. Se le indicó terapia de aprendizaje de relajación del esfínter para coordinar la micción, posteriormente neuromodulación sacra. Durante el seguimiento se observó mejor coordinación y satisfacción después de orinar. CONCLUSIONES: La micción es un proceso complejo, que implica la integridad de la vía urinaria inferior y adecuado sinergismo con el sistema nervioso central, autónomo y somático. La falla en alguna de estas estructuras podría ocasionar un patrón miccional obstructivo.
Abstract BACKGROUND: Fowler's syndrome is a rare phenomenon mainly in young women in reproductive age with abnormal, repeated contractions in the external urethral sphincter without a neurological disease. CLINICAL CASE: 51-year-old woman with pelvic organ prolapse, symptoms of vaginal bulge and difficult micturition. A videourodynamic study was done showing intermittent waveform, detrusor hypoactivity and uncoordinated micturition without incontinence, suggestive of Fowler's syndrome. The patient underwent therapy for sphincter relaxation and sacral neuromodulation with good response. In the follow up with clinical improvement, referring being satisfied after micturition. CONCLUSIONS: Micturition is a complex process that needs integrity of the lower urinary tract and synergy between this and the central nervous system, autonomous and somatic. Failure in any of these structures can result in an obstructive pattern.
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Background: Muscle invasive bladder cancer (BC) has a mortality rate of 50% in 5 years, despite the aggressive treatments currently used. The diagnosis of latent tumor cells in histologically normal lymph nodes (LN) may have prognostic value and may explain the tumoral recurrence in BC. Methods: Here we evaluated the use of the AE1AE3 cytokeratin marker through immunohistochemical examination of LNs to diagnose micrometastasis in patients with BC undergoing radical cystectomy (RC) and lymph node dissection. Sixty-one patients with pN0 diseases who were submitted to RC were studied. Conventional histological evaluation indicated that these patients did not have lymph node metastasis. Histological sections were reviewed and analyzed by immunohistochemistry (IHC) using the AE1AE3 antibody in single sections. Results: The total number of removed LNs was 832, averaging 13.64 LNs per patient. The IHC evaluation revealed that LN from 2/61 (3.27%) patients had micrometastasis. At the time of the last follow-up, 41% of all patients were in complete disease remission and 41.1% had died from BC. Conclusions: Our study shows that histological analysis using hematoxylin eosin (HE) method by experienced pathologists is sufficient for the diagnosis of LN metastasis and, therefore, there is no indication for routine IHC evaluation in patients at histopathological pN0 stage. (AU)
Subject(s)
Humans , Male , Urinary Bladder Neoplasms/diagnosis , Immunohistochemistry/methods , Biomarkers, Tumor , Cystectomy , Neoplasm Micrometastasis/diagnosis , Lymph Node ExcisionABSTRACT
Objective To investigate the expression and clinical significance of survivin and PTEN in bladder transitional cell carcinoma(TCC).Methods The expression of survivin and PTEN was studied by S-P immunohistochemisty in 10 cases of normal urinary bladder tissues and 62 cases of the bladder TCC. Results All the normal urinary bladder tissues showed positive staining pattern of PTEN protein, negative staining pattern of survivin protein, positive rate of PTEN in 62 cases of the bladder TCC is 46.8%,the difference of positive rate between grade Ⅰ and grade Ⅲ was significant(P＜0.05),the difference of positive rate between Tis～T_1 and T_2～T_4 showed a trend of decreasing, but there was no statistically significant difference(P＞0.05);positive rate of survivin in 62 cases of the bladder TCC is 56.5%,the difference of positive rate between grade Ⅰ and grade Ⅲ was significant(P＜0.05),the difference of positive rate between Tis～T_1 and T_2～T_4 was significant too(P＜0.05).The expression of PTEN protein and survivin protein was reversely correlated(P＜0.05).Conclusion The abnormal expression of PTEN protein and survivin protein play an important role in the occurrence and progress of the bladder TCC.It can be regarded as a useful diagnostic marker in the bladder TCC.