Vesicovaginal reflux: recognition and diagnosis using ultrasound.

BACKGROUND: Vaginal reflux is a functional voiding disorder seen in prepubertal girls without anatomical or neurological abnormality. When not associated with urinary tract infections (UTI), asymptomatic bacteriuria, post-void dribbling or daytime enuresis it may be considered a normal finding. OBJECTIVE: To review the radiographic features of vesicovaginal reflux based on multiple imaging modalities. MATERIALS AND METHODS: Three girls aged 11, 13 and 5 years were referred for pelvic US for daytime incontinence, post-void dribbling, frequency and urgency. One girl also had recurrent UTIs treated with antibiotics and was investigated for vesicoureteric reflux with US and voiding cystourethrogram (VCUG). All three were examined with MRI. RESULTS: Imaging appearance common to all three girls was a fluid-filled mass posterior to the bladder that disappeared after voiding. A previous VCUG in one girl had shown contrast medium refluxing into the vagina which disappeared after bladder emptying. Pelvic MRI confirmed the findings in all three girls. CONCLUSION: US examination of a distended bladder followed by a post-void study easily provides the correct diagnosis of vesicovaginal reflux by identifying the vagina as the fluid-filled mass. Treatment involves behavioural modifications. Though well known to urologists, this may be a perplexing pathology for the inexperienced trainee radiologist.

Splenogonadal fusion in a 13-year-old boy with contralateral displaced intra-abdominal testis.

Splenogonadal fusion is a rare congenital malformation characterized by intrauterine fusion of the spleen and gonad. We present a 13-year-old boy referred to our clinic, with left scrotal mass and impalpable testis on the right. The scrotal mass was diagnosed histologically as discontinuous-type splenogonadal fusion and intra-abdominal displaced right testis as germ cell aplasia (Sertoli cell only).

[Evaluation of patients with urogenital trauma managed in a urology clinic]. / Klinikte tedavi edilen ürogenital travma hastalarinin degerlendirilmesi.

BACKGROUND: Ten percent of all traumas, responsible for 14% of all deaths, involve the urogenital system. We retrospectively evaluated the patients with genitourinary trauma who underwent any kind of management modality in our clinics. METHODS: We retrospectively evaluated 108 patients (92 males, 16 females; mean age 35.8+/-17.5 years; range 6 to 87 years) with urogenital trauma between 2003 and 2007 according to age, gender, type of trauma, affected organ, grade of trauma, accompanying other-organ injuries, radiological imaging techniques, and treatment. RESULTS: Sixty-eight patients (63%) had blunt, 25 (24%) had penetrating, and 12 (11%) had iatrogenic trauma, and 3 patients (3%) had spontaneous organ injury. When we considered the affected organ, renal trauma was determined in 34 patients (32%), ureteral trauma in 11 (10%), bladder injuries in 18 (17%), urethral trauma in 27 (25%), testicular trauma in 6 (6%), and penile trauma in 12 (10%) patients. Seventeen patients (50%) had grade 3, 11 (32%) had grade 4 and 6 (18%) had grade 5 renal injury; 6 patients of these cases underwent surgical treatment. CONCLUSION: Our results were parallel to those available in the literature. Due to the lack of sufficient information about urogenital trauma rates in our country, it would be highly useful for reference centers to evaluate and publish their own data.

The long-term results of transurethral vaporization of the prostate using plasmakinetic energy.

OBJECTIVE: To assess the long-term efficacy and the safety of plasmakinetic vaporization of prostate (PKVP, Gyrus Medical Ltd., Bucks, UK) against standard transurethral resection of the prostate (TURP) for symptomatic prostatic obstruction. PATIENTS AND METHODS: Of 75 patients admitted to our clinic with symptomatic prostatic obstruction between 2001 and 2003, 40 who were randomized to undergo either TURP or PKVP, and who had returned for the follow-up, were included in this study. All treated patients completed the 36-months of follow-up; 25 had had PKVP and 15 a standard TURP. After surgery the treatment outcome was evaluated using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q(max)) and long-term complications of surgery. RESULTS: The two groups had similar baseline characteristics. The improvement in both groups was statistically significant for the IPSS and Q(max) at 24 and 36 months vs the baseline values (P < 0.05). The mean (sd) IPSS decreased from 21 (3.4) to 7.1 (1.5) and 7.6 (1.4) after PKVP and from 22 (3.8) to 5.2 (1.1) and 5.7 (1.2) after TURP, at 24 and 36 months, respectively. The mean Q(max) for the both groups increased significantly from baseline values at 2 and 3 years, respectively, at 20.8 (2.4) and 21.8 (3.1) mL/s after TURP, which was statistically significantly better than after PKVP, at 12.5 (2.1) and 14.4 (2.6) mL/s, respectively (P < 0.05). Although three patients (12%) in the PKVP group had TURP at 14, 20 and 36 months, respectively, for residual adenoma tissue, one patient had an additional operation after TURP. Bulbar urethral strictures occurred in one patient in each group, requiring internal optical urethrotomy. Erectile dysfunction was reported by three patients after PKVP (12%) and by two of 15 after TURP who were potent before surgery (P > 0.05). The retrograde ejaculation rates in patients with erectile function were similar in both groups (56% and nine of 15, respectively; P > 0.05). In the PKVP and TURP groups, 12 (48%) and nine of 15 patients were satisfied overall. CONCLUSIONS: Although early results showed that PKVP was a good alternative technique among the minimally invasive methods for surgically managing prostatic obstruction, the clinical outcome of PKVP in the long term was not comparable to the results after TURP.

The effects of human chorionic gonadotrophin on normal testicular tissue of rats: dose-dependence and reversibility.

OBJECTIVE To investigate the effect of human chorionic gonadotrophin (hCG) on rat testicular tissue, and its reversibility and dose dependence. MATERIALS AND METHODS Male Wistar rats were assigned to groups (10 rats/group) receiving 10, 30 or 50 IU/kg hCG subcutaneously once daily for 15 days; 10 controls received subcutaneous isotonic saline. At 1 and 3 months later, five rats in each group were killed and their testes removed. The testes were examined histologically to measure seminiferous tubular diameter and germinal membrane thickness. RESULTS At 1 month after hCG administration, the mean germinal membrane thickness in the testicular tissues of the hCG-treated rats was significantly less than in control rats, and was also significantly different between all of the hCG-treated groups (P < 0.05). However, at 3 months after hCG administration, all histological variables were similar to those in control rats (P > 0.05), and the mean germinal membrane thickness at 3 months after hCG administration was larger than that at 1 month (P < 0.05). There were no significant differences in the mean seminiferous tubular diameter between hCG-treated rats and control rats. CONCLUSION hCG impairs seminiferous tubule histology in the 'normal' descended testes of rats. This effect was dose-dependent, and the changes were reversed at 3 months after treatment. Thus, although hCG therapy might affect the seminiferous tubules of contralateral descended testes in cryptorchid boys, these effects might be reversible.