Paraperitoneal inguinal hernia of ureter.

INTRODUCTION: The ureter is present in surgical field during inguinal hernia repair in 0.5-4% of cases. It typically occurs in obese patients, in men and patients after kidney transplants. Right-sided and indirect location of ureteral herniation prevails. The clinical picture is mostly asymptomatic, but possible manifestations include increased frequency of urination with urgency, nocturia, recurrent pyelonephritis, urosepsis, feeling of incomplete emptying of the bladder, signs of GIT obstruction. Diagnostic methods include retrograde pyelography or CT urography. Surgical treatment is indicated in every case of ureteral herniation. Reposition of the ureter retroperitoneally and standard plasty of the inguinal canal is the method of choice. METHODS: 33 cases of ureteral hernia were reviewed in order to write a systematized review of the topic. The case report describes a 68-year-old patient with prostatic hyperplasia and dysuria treated at our institution. A preoperative CT examination with intravenous contrast showed herniation of the right ureter into the inguinal area with hydronephrosis of 2nd degree. Preoperative insertion of a mono-J stent into the right ureter and reposition of the ureter retroperitoneally followed by hernia repair using alloplastic material was performed. There were no postoperative complications. RESULTS AND CONCLUSION: In risky cases, the surgeon should assume the possible presence of a ureter in the inguinal region. Careful dissection in the inguinal area reduces the risk of iatrogenic damage to the ureter.

Combination treatment with mirabegron and solifenacin in patients with overactive bladder: exploratory responder analyses of efficacy and evaluation of patient-reported outcomes from a randomized, double-blind, factorial, dose-ranging, Phase II study (SYMPHONY).

PURPOSE: This large dose-ranging study explored the benefits of different combinations of mirabegron and solifenacin on health-related quality of life (HRQoL), based on patient-reported outcomes (PROs), and patients ('responders') achieving clinically meaningful improvements in efficacy and HRQoL. METHODS: SYMPHONY (NCT01340027) was a Phase II, placebo- and monotherapy-controlled, dose-ranging, 12-week trial. Adult patients with overactive bladder (OAB) for ≥3 months were randomized to 1 of 12 groups: 6 combination (solifenacin 2.5/5/10 mg + mirabegron 25/50 mg), 5 monotherapy (solifenacin 2.5/5/10 mg, or mirabegron 25/50 mg), or placebo. Change from baseline to end of treatment was assessed, versus placebo and solifenacin 5 mg in: PROs (OAB-q [Symptom Bother/total HRQoL] and Patient Perception of Bladder Condition score), and responders achieving minimally important differences (MIDs) in PROs and predetermined clinically meaningful improvements in efficacy (e.g. <8 micturitions/24 h). Changes in PROs and responders were analysed using an ANCOVA model and logistic regression, respectively. RESULTS: The Full Analysis Set included 1278 patients. Combination therapy of solifenacin 5/10 mg + mirabegron 25/50 mg significantly improved PROs versus solifenacin 5 mg and placebo, and significantly more responders achieved MIDs in PROs and efficacy. Micturition frequency normalization was approximately twofold greater with 10 + 25 mg (OR 2.06 [95 % CI 1.11, 3.84; p = 0.023]) and 5 + 50 mg (OR 1.91 [95 % CI 1.14, 3.21; p = 0.015]) versus solifenacin 5 mg. CONCLUSION: Combining mirabegron 25/50 mg and solifenacin 5/10 mg improves objective and subjective efficacy outcomes compared with placebo or solifenacin 5 mg.

Inflammatory pseudotumour of urinary bladder - a rare cause of massive macroscopic haematuria.

PURPOSE: Authors analyzed their experience with urinary bladder tumours. This article discusses clinical and histopathological diagnostics and treatment procedures, and follow up of patients with rare benign urinary bladder tumours. METHODS: 406 patients with bladder tumours were treated in our department between January 2000 and December 2008. 322 patients had superficial tumours and 84 had primary invasive tumours. All patients who underwent transurethral resections of these tumours were operated under general or spinal anaesthesia. The resected specimens were histologically examined in the department of Pathology. RESULTS: 399 of the 406 patients had urothelial bladder cancer, 7 patients had a histologically uncommon type of bladder tumour, one female was diagnosed with sarcomatoid bladder cancer, one patient had a histologically confirmed feochromocytoma of the urinary bladder. Two males had epidermoid carcinoma. One female had a histologically described uncommon benign pseudoneoplastic lesion, chararacteristic for endosalpingiosis. Another two patients were diagnosed with inflammatory myofibroblastic tumour of the urinary bladder. Both patients presented with gross macroscopic haematuria. Authors performed complete transurethral tumour resections, which required several sessions and the deliberation of a blocked ureter through nephrostomy in one case. CONCLUSION: More than 98 % of all treated patients had urothelial bladder cancer in different stages and grades. Two patients had rare benign inflammatory proliferation of the bladder wall which formed large tumorous bleeding masses obstructing the ureter in one case. These types of bladder tumour could be treated conservatively with meticulous long term follow up similarly to patients with bladder cancer (Tab. 1, Fig. 4, Ref. 15). .

Ileus, pregnancy or leiomyoma? A case of a large intraabdominal tumor.

OBJECTIVE: Authors evaluate a case of an extremely large leiomyoma, its symptomatology, diagnosis and surgical treatment. They present the possible peroperative complications and emphasize the necessity of the interdisciplinary approach. METHODS: The set of patients consists of 21 patients with leiomyomas of various localizations. All patients were operated by means of conventional operation. The material was sent for classical bioptic examination with the use of immuno-histochemical analysis. RESULTS: Unlike found in literature, the most common appearance of leiomyoma in our set of patients was on small bowel, namely 10 of 21 patients had tumors in this localization. Furthermore there were three tumors of gynecological origin. Two of them had acute abdominal disease (AAD) while in these cases, ileus was a reason for urgent operations. In all three gynecological cases it was difficult to diagnose preoperatively the origin of tumors. In one patient, the preparation led to partial iatrogenic lesion of left ureter which was subsequently treated with primary suture. The authors describe zero mortality. CONCLUSION: Despite the relatively simple diagnosis of leiomyomas, in some cases of extreme size of the tumor combined with its localization in the small pelvis makes it difficult to distinguish it from other mesenchymal tumors. In order eliminate the peroperative complications it is possible to introduce a urethral catheter and to set up a multidisciplinary operation team to achieve combined experience (Fig. 5, Ref. 14).

[Splenectomy--a complication of left-sided nephrectomy]. / Splenektómia--komplikácia l'avostrannej nefrektómie.

Iatrogenic injuries of spleen complicating left transperitoneal nephrectomy are the third reason of the injury of the spleen during abdominal surgery. This article deals with procedure of surgical freeing of file spleen from its fixing system with aim to avoid of its injury. Authors revalue all cases of left nephrectomy which was complicated with splenectomy, on their urology department during last ten years.