Acute Infectious Bilateral Vasitis Complicated by Fournier’s gangrene

Acute infectious vasitis is a rare disease of inflammation of the vas deferens and spermatic cord and it is usually unilateral disease Herein we present a case of a 62-year-old male with acute infectious bilateral vasitis. The patient initially was managed conservatively with antibiotics. However, during the course, the scrotum became heavily inflamed, with the production of exudate and the formation of blisters and required surgical exploration. We performed debridement and left orchiectomy due to Fournier’s gangrene. Fortunately, the patient had an uneventful recovery. Vasitis is a rare disease which although it has a benign courses it may be complicated by Fournier’s gangrene. In such a case aggressive surgical treatment will resolve the situation.

Leiomyoma of the Urinary Bladder: A Review and Update

Leiomyoma of the urinary bladder / leiomyoma of the ureter is a very rare benign tumour of smooth muscle origin which has been reported sporadically globally. Leiomyoma of the urinary bladder/ureter may be diagnosed incidentally during investigation of various conditions including infertility and hepatitis. Leiomyoma of the urinary bladder / ureter may manifest in female as well as in a male patient with non-specific symptoms including lower urinary tract symptoms / retention of urine, haematuria, loin pain/discomfort, urinary tract infections and cystitis. The general and systematic examinations may be normal but at times there may be a palpable mass within the area of the urinary bladder on bimanual examination but not always. There may occasionally be tenderness in the loin. The results of routine haematology and biochemistry blood tests would generally tend to be normal but there may be anaemia and impairment of renal function some cases of visible haematuria and obstruction of the ureter respectively. Ultrasound scan would tend to illustrate a well-circumscribed polypoidal soft tissue mass projecting into the urinary bladder or within the intramural area of the bladder. Intravenous urography would show a filling defect in the urinary bladder. CT and MRI scans of abdomen and pelvis with contrast would show a well-defined round mass in the area of the bladder which could be iso-tense to skeletal muscles on T1 and T2 weighted images and occasionally may show cystic areas of necrosis. Cystoscopy would show the lesion projecting into the urinary bladder at the specific area of the urinary bladder involved and at times the projecting lesion would be covered by normal looking urothelial mucosa and on other occasions when the lesion is large and in the area of a ureteric orifice the specific ureteric orifice would not be visualized. Diagnosis of leiomyoma of the urinary bladder / ureter would be confirmed upon histopathology and immunohistochemistry study features of trans urethral resection biopsies of the lesion which would tend to show smooth muscle spindled-cells with no evidence of atypia, or necrosis, or haemorrhage and associated with a low Ki67 index. Trans-urethral resection of the urinary bladder lesion tends to be undertaken for small to medium sized lesions with good outcome but this tends to be associated with about 18% recurrence rate that would require further resections or surgical excision to ensure complete removal of the lesion and no further recurrences. Surgical excision of the lesion including partial cystectomy, local excision / enucleation have been very effective for the treatment of larger leiomyomas with no reported recurrence so far; nevertheless, patients who undergo augmentation cystoplasty or total cystectomy and urinary diversion would need to cope with the functional problems related to the cystoplasty or urinary diversion. Differential diagnoses of leiomyoma of the urinary bladder / ureter include leiomyosarcoma, urothelial carcinoma and other malignant lesions affecting the urinary bladder. There is need for clinicians to explore minimal invasive surgery to treat patients who have leiomyoma of the bladder / ureter especially those who have multiple co-morbidities and the alterative management options that could be undertaken in multi-centre trials include: Cryotherapy, radiofrequency ablation, irreversible electroporation, high frequency ultrasound treatment and super-selective embolization of the arterial branch supplying the leiomyoma. Patients who develop ureteric obstructions would additionally require nephrostomy insertions or insertion of ureteric stents as a temporary measure to improve their renal functions.

Study the Anatomy and Physiology of Body's Urinary System and Fibromyalgia Syndrome (FMS) for the Design an Intelligent Alarm System for Monitoring of FMS

In recent years, chronic medical problems have become increasingly prevalent. Chronic ‎illnesses challenge the view of life as a regular and continuous process, a challenge that has ‎important psychological consequences. The long duration of people suffering from these ‎diseases, the long process of treatment and the fact that there is no proper and definitive ‎treatment for most of these diseases and their associated complications have made chronic ‎diseases a detrimental factor in public health. According to the World Health Organization ‎‎(2006), the prevalence of chronic and non-communicable diseases is increasing in all countries, ‎especially developing countries, so that the major challenge for the health system in the present ‎century, is not living people, but better adapted to chronic illnesses and maintaining their ‎mental and social health and well-being Ed's life-threatening chronic physical illness.‎ Chronic pain is a pain that lasts longer than usual, and according to the criteria of the ‎International Association of Pain, this time is defined as at least 3 months to 6 months. Chronic ‎pain is such that not only faced the sick person whit the pressure of the pain but also with many ‎other pressure that affect different parts of her life. Fibromyalgia is one of the most rheumatologic disorders and one of the most resistant chronic ‎pain syndromes. Fibromyalgia is one of the most common musculoskeletal disorders in adults ‎and chronic pain is one of the most common complaints in this group of patients.

Prostatic Artery Embolization (PAE) As Treatment for Lower Urinary Tract Obstruction Due To Benign Prostatic Hyperplasia: An Update of the Literature

Prostate artery embolization (PAE) as treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) was first undertaken in 2000 and since then utilization of PAE for the treatment of symptomatic BPH associated with failure of medical therapy or patients not being fit to undergo general anaesthesia or spinal anaesthesia for surgical treatment of the prostate gland has continued to be undertaken by well trained interventional radiologists in various well equipped interventional radiology units globally especially in the developed countries. PAE is a technically demanding procedure which is only undertaken by well trained interventional radiologists. PAE is undertaken under radiology imaging control via the left or right femoral artery or the radial artery under local anaesthesia. Super-selective catheterization of the small prostatic artery is undertaken with the use of fine microcatheters that traverse the pelvic arteries / internal pudendal arteries. The PAE procedure does involve introduction of microparticles to completely block the prostate arteries. The embolization agents include polyvinyl alcohol (PVA) and other synthetic materials including microspheres. Successful PAE does lead to necrosis and shrinkage of the prostate gland. With regard to the technical details of PAE, the interventional radiologist does obtain access into the arterial system by piercing the femoral artery or the radial artery under radiology imaging control including ultrasound scan with utilization of a trocar which is hollow. A guide-wire is threaded through the trocar and trocar is then removed. A cannula is passed over the guide-wire and once the cannula is in place the guide-wire is removed. The cannula does allow a sheath to be inserted into the artery. Contrast material is injected through the sheath under radiology imaging / fluoroscopic control which does allow the anatomy of the pelvic blood vessels to be illustrated including the anatomy of the internal pudendal artery as well as if the anatomy is normal or there is a variation in the anatomy of the pelvic vessels including whether or not there is tortuosity of the pelvic vessels or atherosclerosis of the vessels. The contrast angiography is utilized to guide the interventional radiologist to identify the prostate artery in order to advance the catheter to the ostium of the prostatic artery and this then enables the radiologist to inject polyvinyl alcohol or microspheres into the prostatic artery. The anatomy of the pelvic vessels does vary which is well known by all interventional radiologists. Successful PAE does refer to complete bilateral embolization of the prostatic arteries but at times the radiologist is only able to undertake unilateral embolization of a prostatic artery due to a variant anatomy of the pelvic vessel or tortuosity of the vessel or atherosclerosis. Over the past 18 years various case reports, case series, and studies of PAE either alone or in comparison with trans-urethral resection of the prostate have been reported in various journals. These publications have mostly shown that PAE is safe and efficacious in improving upon the IPSS, QoL, Q-max, Post -void residual urine volume, as well as reduction in the volume of the prostate. Some of the studies have shown almost equivalent in the IPSS improvement in comparison with the IPSS improvement pursuant to TURP. Nevertheless, some of the reported improvements in other functional outcomes have not been as good as that obtained following TURP. Additionally the studies had been reported with short and medium term-follow-up only hence generally one cannot confidently state what the overall long-term outcome of PAE would be. Nevertheless, PAE has be associated with minor complications mainly and not with major complications including major bleeding. TURP tends to be associated with higher incidence of retrograde ejaculation and erectile dysfunction in comparison with PAE in which the sexual function tends to remain stable. PAE tends to be associated with retention of urine / long period of urethral catheterization in comparison with TURP. The overall cost of PAE tends to be much cheaper in comparison with TURP because of the fact that PAE tends to be undertaken as an outpatient procedure without any hospitalization cost. Specific complications which could occur include non-target embolization that could lead to transient rectitis, or penile ulcer, urinary tract infection, and dysuria. PAE may be associated with pelvic and urethral pain of more than 1 to 3 days but PAE is not associated with dilutional hyponatraemia which occasionally occurs following TURP. There is need for more studies to be undertaken on PAE and to be reported with long-term follow-up to enable a consensus opinion to be made about the long term outcome of PAE. Meanwhile PAE could be undertaken on individuals who have failed medical therapy who are not fit to undergo surgery or who do not want to undergo surgery.

Malakoplakia of the Kidney: A Review and Update of the Literature

Malakoplakia of kidney (MOK) is a very uncommon disease. Various internet data bases were searched to review the literature on MOK. Results obtained from reported cases and discussions relating to MOK did reveal the ensuing: MOK is a rare chronic inflammatory disease; MOK can affect kidneys in adults and children including transplanted kidneys and the immunosuppressed. MOK often tends to be associated with chronic / long term urinary tract infections especially coliforms. The manifestation of MOK is non-specific including fever, lethargy, loin pain, haematuria and loss of weight plus other non-specific symptoms. The radiology imaging appearances tend to be non-specific (normal, mimicking abscess or renal carcinoma or other chronic inflammations of kidney. Diagnosis of MOK has been established through histological examination of biopsy specimen of the lesion, FNA, or nephrectomy specimens by presence of histiocytes with Michaelis-Gutmann bodies. PCR may also be used to identify E coli in kidney tissue. MOK can be successfully treated by utilizing antibiotics (quinolones) but nephrectomy has been undertaken because of the lesion mimicking renal carcinoma. MOK does tend to be associated with coliform infections, the immunosuppressed and may mimic malignancy of the kidney. If a lesion in the kidney is associated with recurrent coliform infection / immunosuppression, MOK should be suspected and radiology imaging biopsy of the suspected renal lesion should be undertaken for the diagnosis to avoid unnecessary nephrectomy. Nevertheless, some complicated cases of MOK do need to be effectively treated by means of neohrectomy.

Endometriosis of the Urinary Bladder and Ureter: A Review and Update of the Literature

Endometriosis of the urinary bladder and / or ureter are diseases that may occur alone or in association with endometriosis elsewhere in the pelvis or other sites of the body in women between the 2nd decades of life and the fifth decades of their lives typically in women who are menstruating but endometriosis of urinary bladder may occur / present in post-menopausal women on very rare occasions or in women with a past history of treatment for endometriosis elsewhere. Endometriosis of the urinary bladder and / or endometriosis of the ureter are uncommon diseases which tend to be reported sporadically globally. Endometriosis of the urinary bladder and / or ureter may be asymptomatic in some patients but other cases of endometriosis of the urinary bladder / and or ureter tend to present with non-specific symptoms including: suprapubic pain, urinary frequency and urgency, loin pain, dyspareunia, dysmenorrhoea, cyclical dysuria, and other non-specific symptoms including loin pain and infertility. A high-index of suspicion is required in order to diagnose the disease early with utilization of (a) various radiology imaging including ultrasound scan of pelvis and urinary tract, computed tomography scan of pelvis and urinary tract, or magnetic resonance imaging (MRI scan of pelvis and renal tract, (b) laparoscopy and biopsy of the endometriosis lesion for histopathology examination including immunohistochemistry studies of the specimen, (c) cystoscopy examination for further assessment. Diagnosis of endometriosis of the urinary bladder and / or ureter tends to be confirmed by pathology examination finding of endometrial glands and stroma in the excised or biopsy specimen and immunohistochemistry staining studies tend to exhibit the following features: (a) the endometrial stromal cells of endometriosis tend to stain positively upon immunohistochemistry staining for CD 10; (b) the glandular component of endometriosis does exhibit positive nuclear staining for p63; (c) the glandular component of endometriosis also stains positively for: CK7, ER oestrogen receptor, PR progesterone receptor; (d) endometriosis specimens also usually stain positively for: CA125. Treatment for endometriosis of bladder and or ureter could be conservative with inclusion of hormonal treatment, pain relief, and medications to reduce urinary bladder symptoms and this tends to be effective in many cases but recurrences tend to be higher in most cases in comparison with surgical treatment. Some of the surgical treatment for endometriosis of urinary bladder includes partial cystectomy ensuring completed excision of the endometriosis lesion or submucosal excision of the urinary bladder endometriosis lesion but leaving an intact urinary bladder mucosa. Surgical treatment of endometriosis of the ureter tend to involve (a) complete excision of the endometriosis segment of the ureter and end-to end ureteric anastomosis, or excision of the endometriotic ureter segment with either Boari-flap ureteric anastomosis to the urinary bladder or Psoas hitch anastomosis. Complication may occur following various treatment options adopted for the disease of the ureter and urinary bladder including recurrence, urinary urgency and urge incontinence, urinary stress incontinence, ureteric stenosis / stricture, vesico-ureteric reflux and these complications need to be treated and a long-period of follow-up would be required in order to also diagnose the late complications of the disease. Surgical excision surgery in the developed countries tend to be undertaken by the laparoscopic technique but in the developing countries that do not have facilities for laparoscopic surgery the open technique would tend to be adopted for all surgical treatment options of the disease.