Septic shock caused by the under-recognized bacterium Eggerthella lenta in a 61-year-old male with a periurethral abscess: a case report

Abstract Eggerthella lenta is a gram-positive anaerobic bacillus that has been associated with life-threatening infections. Bacteremia is always clinically significant and is mostly but not always associated with gastrointestinal disease. We present a unique case of abrupt deterioration and rapid development of septic shock secondary to periurethral abscess caused by E. lenta infection. This case highlights the atypical clinical presentation, risk factors, uncommon source of infection, challenges in therapy, and outcome of this infrequent infection. There is still a gap in the understanding of E. lenta pathogenicity, and more literature is needed to establish clear management recommendations.

Application of dermoscopy image analysis technique in diagnosing urethral condylomata acuminata

Abstract: Background: In this study, cases with suspected urethral condylomata acuminata were examined by dermoscopy, in order to explore an effective method for clinical. Objective: To study the application of dermoscopy image analysis technique in clinical diagnosis of urethral condylomata acuminata. Methods: A total of 220 suspected urethral condylomata acuminata were clinically diagnosed first with the naked eyes, and then by using dermoscopy image analysis technique. Afterwards, a comparative analysis was made for the two diagnostic methods. Results: Among the 220 suspected urethral condylomata acuminata, there was a higher positive rate by dermoscopy examination than visual observation. Study limitations: Dermoscopy examination technique is still restricted by its inapplicability in deep urethral orifice and skin wrinkles, and concordance between different clinicians may also vary. Conclusion: Dermoscopy image analysis technique features a high sensitivity, quick and accurate diagnosis and is non-invasive, and we recommend its use.

Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - a pilot study

ABSTRACT Objectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)? Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome. Results Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20). Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.

Urethral diverticulum in females: 25 years experience at Ramathibodi Hospital.

We retrospectively reviewed the urethral diverticulum in females from 1972 to 1997. Sixty seven patients were found in this study. Nine per cent were nulliparous and the rest were multiparous with the mean of 2.2 births (range 1-6). Voiding cystourethrography and intravenous pyelography were the main diagnostic investigations (92.4%). Stones in the diverticulum were found in 4.4 per cent. The treatment included marsupialization for the diverticulum at distal urethra in 14 per cent and diverticulectomy for the diverticulum at middle and proximal urethra in 86 per cent. The complications included 1.4 per cent of stress incontinence and 4.4 per cent of recurrent infection.

Posterior urethral valves. Clinical and radiological aspects

From the study of 14 cases of posterior urethral valves, the authors recall the different clinical aspects which can reveal this malformation and emphasize the baby form which may be misleading. They therefore note that the child's from is more frequent in their series which is explained by the usual diagnostic delay, and the ignoring of this entity. They also recall the modalities of radiological exploration [intraveinous urography, public cystography and ultrasound] as well as the data of endoscopic and urodynamic explorations