ABSTRACT
We report co-occurrence of emphysematous cystitis and emphysematous pyelonephritis (EC/EPN) in a 64-year-old female with poor-controlled diabetes mellitus (DM) that presented with flank pain, fever, and hematuria that turned out to have a bilateral extrarenal pelvis. On examination, she was feverish, and the costovertebral angle was tender. By considering herhemoglobin A1C, her DM was out of control. Inflammatory markers elevated. Renal function tests were impaired. Urine culture was positive for extended-spectrum beta-lactamase Escherichia coli. Computed tomography scans (CT) confirmed the presence of air in the bladder and renal pelvis in favor of EC and unilateral EPN. We planned to use conservative treatments. Promptly intravenous antibiotics started; thereafter, the renal pelvis was drained via percutaneous catheter, and the bladder was drained via foley catheter, as well. After 14 days of hospitalization, clinical status improved, urine culture got negative, and emphysema in follow-up CT images wholly regressed. To our knowledge, co-occurrence of emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) in a patient with an extra renal pelvis never happened. We tend to convey messages, including (1) the extrarenal pelvis may contribute to predisposing the patient to pyelonephritis if it is considerably large; (2) the conservative plan and observation was a successful experience in treating extrarenal pelvis patients with EC/EPN.
ABSTRACT
BACKGROUND: Benign prostatic hyperplasia (BPH) is the most common benign mass in men, there are not standard parameter for diagnosis of BPH based on ultrasound bladder parameter, so the aim of the study was correlation between ultrasound bladder parameters with severity of symptoms and response to treatment in patients with benign prostatic hyperplasia under medical treatment. METHODS: This prospective cross-sectional study was performed on 100 men over 40 years of age with a diagnosis of BPH referred to the urology clinics of Al-Zahra and Khorshid hospitals, Isfahan, Iran in 2018-2020. The International Prostate Symptom Score (IPSS), bladder wall thickness, bladder weight, Intravesical prostatic protrusion (IPP) and response to treatment were examined before and after treatment. Patients underwent standard drug treatment with a Tamsulosin 0.4 mg daily and finasteride 5 mg daily for BPH and followed for a period of 3-6 months. RESULTS: There were significant differences between severity of symptoms before treatment with age, bladder was thickness, bladder weight and IPP (P<0.001). The symptoms of 76 patients were recovered and 24 patients not changed After treatment, so the patients were compared based on outcomes to treat, all patients with mild symptoms, 28 patients with moderate symptoms and 18 patients with severe symptoms were recovered, so the treatment outcome was significant based on symptoms (P<0.001). The means of age, bladder wall thickness and bladder weight in recovered group was significantly lower than not changed group (P<0.001). Also the frequency of IPP in the recovered group was significantly lower than not changed group (P<0.001). CONCLUSION: The use of ultrasound parameters has a high value in determining the response to treatment in BPH patients and the diagnostic value of IPSS, IPP, bladder wall thickness and bladder weight were important determined response to treatment and severity of disease. Also relation between bladder weight with response to treatment and severity of disease were evaluated for first time in the current study.
