Bacillus Calmette-Guérin (BCG) prostato-epididymitis in a patient treated for a non-invasive urothelial cancer: A case report.

Introduction: The Bacillus Calmette-Guérin (BCG) used as anti-tuberculous vaccine is also a well-known therapy for superficial urothelial cancer. Local or general side effects can occur, although it is generally well tolerated. Case: We present the case of a 65 year-old caucasian man consulting for gross hematuria and lower urinary tract symptoms. Magnetic resonance imaging (MRI) demonstrated a non-invasive urothelial carcinoma (NMIBC) and Prostate Imaging-Reporting and Data System (PIRADS) IV lesions. Transurethral resection of the bladder tumor revealed a non-invasive transitional cell carcinoma. Intravesical Bacillus Calmette Guerin (BCG) therapy was provided. After 6 intravesical instillations, the patient presented with prostato-epididymitis. Forthcoming BCG instillations were canceled, and cancer treatment was switched to epirubicine. Treatment with ethambutol, rifampicin and isoniazid was started with rapid resolution of the symptoms. Urinary and semen cultures grew Mycobacterium tuberculosis complex strain BCG. As prostate specific antigen (PSA) rose, prostate's biopsies were performed showing extensive necrosis boarded by granulomas without signs of malignancy. Discussion: BCGitis is a rare complication in patients treated for non-invasive urothelial cancer. Several risk factors, local and systemic, should be considered prior to this immunotherapy. BCGitis (local or disseminated) or hypersensitivity reactions to BCG must be included in the differential diagnosis even if therapy was administered several years before the symptoms. Adequate treatment must be started as fast as possible to avoid serious complications.

Encrusted Uropathy: A Comprehensive Overview-To the Bottom of the Crust.

Encrusted uropathy is a rare subacute to chronic inflammatory disorder caused by infection with urease-producing bacteria, mainly Corynebacterium urealyticum. The disorder is characterized by urothelial deposition of struvite and carbonated apatite, resulting in encrustations and ulceronecrotic inflammation of the urothelium and surrounding tissues. Most commonly, encrusted uropathy is encountered in patients with predisposing conditions. The disease remains underdiagnosed. High urinary pH and negative conventional urine cultures should raise suspicion of the diagnosis. Prognosis is dependent on timely diagnosis and treatment installment, which consists of urological removal of encrustations in combination with urinary acidification and long-term antibiotic therapy.

Segmental testicular infarction: a case report.

BACKGROUND: Segmental testicular infarction is a very rare condition, which can mimic a testicular torsion or testicular cancer. Correct diagnosis is difficult but it is important to avoid unnecessary radical treatment. CASE PRESENTATION: We report a clinical case of a 36-year-old white man who presented at our emergency department with subacute testicular pain. A urine analysis, Doppler ultrasound, surgical exploration, blood analysis, and magnetic resonance imaging were performed to diagnose his condition, to exclude a testicular torsion, and to raise confidence in its non-malignancy. He was treated conservatively. At follow-up, a few months after the incident, he no longer had complaints. Ultrasonography showed remaining hypo-echogenicity of the left upper pole, indicating a sequel of ischemia. CONCLUSIONS: Segmental testicular infarction is a rare condition which can be easily confused with a testicular torsion or a testicular tumor. This case report can be helpful in recognizing and diagnosing this condition. Making the right diagnosis is important since it can prevent an unnecessary radical treatment.

Urinary incontinence in patients with cystic fibrosis.

OBJECTIVE: Owing to evolution in treatment, the average life expectancy of patients with cystic fibrosis (CF) has increased. This has been followed by an increase in urological complications such as urinary incontinence. As stress incontinence occurs during exercise, it may have a negative effect on the implementation of respiratory physiotherapy. The purpose of this study is to determine the prevalence of urinary incontinence and its effect on the quality of life and physiotherapy in a population with CF. MATERIALS AND METHODS: Questionnaires were used to determine the prevalence of incontinence in patients of the Cystic Fibrosis Clinic of the University Hospital in Brussels. Two different surveys were used, depending on the age of the patients (< 12 or ≥ 12 years). The different characteristics of incontinence were emphasized. RESULTS: Questionnaires were completed by 122 participants aged 6-59 years, showing an overall prevalence of 27% for urinary incontinence. Mainly adults reported urinary incontinence, with a prevalence of 11% in men and 68% in women aged 12 and above. The amount of urinary leakage was usually only a few drops and it was mainly triggered by coughing. Many of the participants had never mentioned this symptom to anyone. CONCLUSIONS: Doctors' and physical therapists' attention should be drawn to the fact that urinary incontinence is part of the complication spectrum of CF. A quarter of the study population refrained from coughing up phlegm and from physiotherapy. It is important to actively question and inform about this problem, to enable its detection and treatment.

Knowledge about human papillomavirus and the human papillomavirus vaccine in Belgian students.

INTRODUCTION: The aim of this study was to examine the knowledge of Belgian university students about the human papillomavirus (HPV) and HPV-vaccination. MATERIAL AND METHODS: During a period of two months we administered an online questionnaire, which contained 29 questions, to 3332 students of the Free University of Brussels. Of the 433 completed questionnaires, 346 were included by age (18-30 years) and completeness of responded questionnaires. These formed the study group. RESULTS: Of the 346 included questionnaires (76% female), 48% were completed by medical students. The majority (65%) knew that both genders could be infected with HPV. Ninety-five percent of all medical students were aware of the existence of HPV, while 92% knew of the possibility to be vaccinated against the virus. Ninety percent of them were aware of the causal relationship between HPV infection and cervical cancer. 46% of the medical students were aware that HPV can cause anogenital cancers, and only 28% knew that HPV-vaccination could protect them against genital warts. Sixty percent of all female students were fully vaccinated against HPV, without any difference between medical and non-medical students. A very small part of all students (3%) believed that vaccination against HPV could enhance a promiscuous lifestyle. CONCLUSIONS: Almost 80% of respondents were aware of the existence of the human papillomavirus, its morbid potential and the HPV-vaccination.

Tamoxifen to treat urge-incontinence from an isolated bladder metastasis of a primary breast cancer.

OBJECTIVES: Managing urge-incontinence after metastatic lobular carcinoma of the breast into the bladder. MATERIAL AND METHODS: Case report and review of the pertinent English language literature. RESULTS: Conservative management with tamoxifen resulted in clinical and partial radiological remission and the urge-incontinence disappeared. CONCLUSION: A conservative mode of treatment is possible for metastatic lobular carcinoma of the breast into the bladder.