Is urethritis accompanied by seminal vesiculitis?

OBJECTIVE: To determine whether urethritis is accompanied by seminal vesiculitis using transrectal ultrasound (TRUS) imaging. METHODS: Fifty-six male patients (mean age 31.6 8.7 years) with urethritis were included in the study. As a control group,we also considered 34 healthy volunteers (mean age 21.3 1.8 years). The two groups were evaluated by the nucleic acid amplification test and imaging studies using TRUS. RESULTS: The nucleic acid amplification test could identify 15 patients (26.8%) with gonococcal urethritis (five had accompanying chlamydial urethritis), 32 (57.1%) with chlamydial urethritis, and nine (16.1%) with nongonococcal and nonchlamydial urethritis. The mean anteroposterior diameter of the bilateral seminal vesicles was significantly longer in the urethritis group than in the controls (12.9 3.3 mm vs 11.0 2.0 mm, P = 0.004). The incidence of dilatation or cystic changes of seminal vesicles was significantly higher in the urethritis group than in the controls (dilatation: 30% vs 9%, P = 0.019; cystic change: 39% vs 12%, P = 0.007). There was no significant difference in the incidence of dilatation or cystic changes of seminal vesicles between gonococcal urethritis and chlamydial urethritis. CONCLUSIONS: Patients with urethritis are likely to have accompanying seminal vesiculitis. This suggests a close interrelationship among urethritis, seminal vesiculitis and epididymitis.

[Cystic ureteritis in a kidney transplantation candidate]. / Ureteritis quística en paciente candidata a trasplante renal.

Cystic ureteritis is a very uncommon pathology, whose pathogenesis is not well established. It is usually asociated with chronic infectious factors. It presents unspecific symptoms but characteristic radiologic findings. There is not an especific treatment for this disease. Kidney transplant is the final pathway for patients with chronic renal failure. We report a case of cystic ureteritis diagnosed during pre-transplant study.

Tc-99m ciprofloxacin imaging in diagnosis of chronic bacterial prostatitis.

AIM: To investigate the value of Tc-99m ciprofloxacin imaging in the differential diagnosis of chronic bacterial prostatitis. METHODS: The study included 4 normal subjects as the negative controls, 2 patients with acute prostatitis or cystourethritis as the positive controls and 59 patients diagnosed as chronic bacterial prostatitis or chronic pelvic pain syndrome by traditional laboratory tests. In every subject, the single photon emission computerized tomography images were obtained 3 h after intravenous injection of Tc-99m Ciprofloxacin. The results of the imaging were compared with those of laboratory tests. RESULTS: On the images, negative uptake was observed in all normal subjects, while strong hot uptake, in the whole prostate of acute prostatitis patients and in the whole urethra of acute cystourethritis patients. In 13 (68%) of 19 patients categorized as chronic bacterial prostatitis by standard laboratory tests, hot uptake with less intensity than that of acute prostatitis was observed in the prostate area around the prostatic urethra. Negative uptake in the prostate was observed in 6 of 19 patients (32%) categorized as chronic bacterial prostatitis. Interestingly, hot uptake in the prostate was exhibited in 28 (70%) of the 40 patients categorized as chronic pelvic pain syndrome. CONCLUSION: Tc-99m ciprofloxacin imaging is helpful in the differential diagnosis of prostatitis syndrome.

Diagnosis and imaging in urinary tract infections.

The aim of imaging in urinary tract infection is to detect conditions that must be treated in order to avoid immediate deterioration or recurrences, and probable long-term kidney damage. In newborns identified with hydronephrosis during pregnancy or by neonatal screening, vesicoureteral reflux and renal scarring are congenital and not caused by infection. Most of these patients are male and the vesicoureteral reflux is of a higher grade than that detected in girls having had urinary tract infection. In children with urinary tract infection, several authors advocate a more selective policy and recommend imaging only in those children who are at risk for developing renal damage. In adult females no imaging is necessary in cystitis, whereas ultrasonography and plain films are recommended in acute pyelonephritis. Because uncomplicated urinary tract infection in men is rare, diagnostic evaluation including imaging should be started early in order to rule out complicating factors within the urinary tract. The role of imaging in prostatitis, vesiculitis, epididymitis and orchitis is primarily to rule out abscess formation, but also to exclude testicular malignancies.

Sonography of the female urethra.

OBJECTIVE: The purpose of this study was to explore the role of sonography for women with urethral symptoms and a suspected urethral diverticulum. SUBJECTS AND METHODS: Nineteen women with urethral symptoms underwent voiding cystourethrography (VCUG) and transvaginal, transperineal, and urethral sonography (using a catheter-based transducer). VCUGs and sonograms were evaluated for diverticula, defined on sonography by direct visualization of the neck connecting the periurethral sac with the urethral lumen. The diverticular neck, size, location, and shape were noted. Lesions revealed by sonography as not connected to the urethra were also noted. RESULTS: Of 19 women, 14 had urethral diverticula and one had two diverticula, for a total of 15 diverticula. On sonography the diverticula ranged in diameter from 2 mm to 5 cm. Both sonography and VCUG showed 13 of the 15 diverticula. In addition, sonography revealed two infected periurethral cysts, a periurethral leiomyoma, a diffuse urethritis, and scarring or deformity of one patient's urethra from a prior diverticulectomy. On sonography, eight of the 13 diverticula wrapped around more than 50% of the urethral circumference. The neck was precisely seen (by definition) in 13 of 15 diverticula on sonography and in two of 13 diverticula on VCUG. CONCLUSION: Sonography is useful in this group of women with urethral symptoms and suspected urethral diverticula. It provides information on the extent and location of the diverticular neck, both of which are important in surgical excision. Also, sonography provides information on lesions not connected to the urethra. Sonography may prove useful in a broader group of women with urethral symptomatology.

Bacteriologic, histologic and ultrasonographic findings in strictures recurring after urethrotomy. A preliminary study.

Twelve men with recurrent anterior urethral stricture after endoscopic urethrotomy (2-12 attempts) underwent open urethroplasty with en bloc removal of diseased urethral segments. Bacteriologic and histologic studies of the excised urethral tracts (mucosa and spongiosum tissue) were performed. The bacteriologic findings were compared with the results of preoperative urine cultures and urethral swabs for chlamydia. The histologic findings were related to preoperative ultrasonographic observations, in order to evaluate the accuracy of ultrasonography in depicting structural changes in spongiosum around the strictured urethral tract. Beta-haemolytic streptococci and Streptococcus faecalis were cultured from the excised spongiosum, without correlation to the preoperative culture results. The histologic studies confirmed the usefulness of urethral ultrasonography for accurate demonstration of the inflammatory changes involving spongiosum around the strictures.

Transrectal ultrasound in male urethritis.

OBJECTIVE: To assess the prevalence of prostatic abnormalities in men with gonococcal and non-gonococcal urethritis using trans-rectal ultrasonic markers. DESIGN: A case control study of patients attending a department of genitourinary medicine with symptoms of urethritis. SETTING: Department of Genitourinary Medicine and Department of Radiology in Manchester Royal Infirmary. RESULTS: A total of 42 patients were recruited to the study: 26 with urethritis and 16 controls. Of the 26 study patients, six were gonococcal, four chlamydial, two mixed gonococcal and chlamydia and nine non specific (no organisms detected). Of the 26 study patients, 16 had abnormal scans (61.5%), eight from the chlamydia group and eight from the non specific group. No abnormalities were found in the gonococcal and mixed group. Of the 16 control patients, five had abnormal scans (31.25%), three of these have had a past history of chlamydial urethritis. CONCLUSION: The prevalence of prostatic abnormalities in patients with non-gonococcal urethritis was significantly higher when compared with controls. The cause of these abnormalities is unclear, but is compatible with inflammatory changes within the gland.

[Urethral duplication in the male]. / Harnröhrenduplikation beim Mann.

The rare duplications of the male urethra--only 210 cases are described till now--are found as many different variations. Only few of these malformations are symptomatic. The embryology is not always clear. Several classifications have been proposed, often too complicated or incomplete. We think, that our classification avoids these disadvantages. Each duplication is systematically classified in a morphological way according to the type of orifice (epispadiac, normotopic on the glans, hypospadiac, perineo-anal), without urinary transport (distal abortive types) or with urinary transport. The latter type can be complete (if a channel exists between bladder and an external meatus) or incomplete (if a channel exists between bladder and any point of the normal urethra or between the normal urethra and any accessory meatus). Four cases are reported and therapeutical aspects are discussed.

Postvoid film of intravenous pyelogram in diagnosis of urethral diverticulum.

Urethral diverticulum is a correctable cause of lower urinary tract symptoms in women. It has been found to be present in from 1.85 to 4.7 per cent of all females. The postvoid film of the intravenous urogram (IVP) is the simplest and least invasive method available to diagnose urethral diverticula. It should be a routine part of the IVP in women with lower urinary tract symptoms.

Urethral syndrome in women.

The pathological changes in the female urethra, para-urethral glands, and bladder neck, which manifest clinically as urethral syndrome, produce radiological signs which are recognizable but for which the authors have not found previous reports. The radiographic manifestations of this disease are clearly demonstrated by excretory urography. These changes are shown to correlate closely with the findings of cystography.

[Radiological features of urinary tract infection in childhood (author's transl)]. / Aspectos radiológicos de las infecciones urinarias en la infancia

The diagnosis of one documented urinary tract infection in children establishes indication for carrying out a radiologic investigation of patient's urinary tract. Such an approach is mostly aimed at recognizing the presence of predisposing factors such as congenital malformations. Upon mentioning available techniques and its indications, the author describes radiologic findings of the most common inflamatory diseases of the urinary tract in childhood.

Inflammatory changes in the non-infected prostate gland. A clinical, microbiological and histological investigation.

PIP: 36 patients (18 with chronic prostatitis and 18 with chronic urethritis) were studied to determine the incidence and nature of prostatic inflammatory changes in patients with clinically diagnosed chronic prostatitis and chronic urethritis without the occurrence of aerobic and anaerobic bacteria, Mycoplasms, and fungi or viruses in the prostatic tissue or prostatic secretion. Excretory urography (IVP), cytoscopy and urethroscopy were performed on all patients. Prostatic biopsy was done transperineally by the method of Veenema. None of the biopsy specimens exhibited acute inflammatory changes. Chronic inflammation in the form of infiltration around the acini with mononuclear inflammatory cells occurred without simultaneous infection in 17 cases. Changes were slight in 11 cases, moderate in 5 and severe in 1. No relationship was found between changes in the appearance of epithelium and occurrence of inflammatory changes. Causes of inflammatory reaction is not known. Current research is being done to determine possible cell-bound hypersensitivity using lymphocyte migration technique.^ieng