Vesical Gossypiboma with Urethral Migration Causing Acute Urinary Retention: A Case Report and Review of the Literature

Abstract Introduction: Vesical gossypiboma is a retained surgical sponge in the urinary bladder following abdominal or pelvic surgery. It is probably under-reported due to medico-legal issues. It usually poses a diagnostic challenge to clinicians. A high index of suspicion is essential to make a timely diagnosis. Case Presentation: We present a case of vesical gossypiboma in a 64-year-old male patient who presented with a history of persistent lower urinary tract symptoms (LUTS) and acute urinary retention following trans-vesical prostatectomy. The urinary retention was relieved by a suprapubic cystostomy. On cystoscopic examination, a large whitish spongiform structure in the urethra and bladder was revealed. A gentle attempt of cystoscopic removal was failed. At exploration, a retained surgical sponge was revealed and removed from the bladder. Postoperatively, the patient reported improvement of symptoms and was passing urine normally. Discussion Vesical gossypiboma is relatively rare as very few isolated cases have been reported, and its migration through the urethra is even rarer. Patients with intravesical gossypiboma may manifest with either acute or chronic symptoms due to complications. Gossypiboma is an avoidable condition, and its occurrence can be prevented by thorough exploration of the surgical site and count of surgical materials at the end of the procedure. Conclusion Vesical gossypiboma should be considered as a differential diagnosis in patients with persistent LUTS following open bladder or prostate surgery. Open surgical removal is one of the feasible treatment options. But prevention is a preferable solution.

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Vesical Gossypiboma with Urethral Migration Causing Acute Urinary Retention: A Case Report and Literature Review

10.21203/rs.3.rs-1223212/v1 ◽

2022 ◽

Author(s):

Kaleab Habtemichael Gebreselassie ◽

Ferid Ousman Mummed ◽

Fitsum Gebreegziabher Gebrehiwot ◽

Mubarek Bargicho Adam ◽

Ramzi Yesuf Adam ◽

...

Keyword(s):

Urinary Retention ◽

Acute Urinary Retention ◽

Treatment Options ◽

Pelvic Surgery ◽

Surgical Removal ◽

Diagnostic Challenge ◽

Surgical Sponge ◽

Retained Surgical Sponge ◽

Patient Reported ◽

High Index Of Suspicion

Abstract Introduction: Vesical gossypiboma is a retained surgical sponge in the urinary bladder following abdominal or pelvic surgery. It is probably under-reported due to medico-legal issues. It usually poses a diagnostic challenge to clinicians. A high index of suspicion is essential to make a timely diagnosis. Case Presentation: We present a case of vesical gossypiboma in a 64-year-old male patient who presented with a history of persistent lower urinary tract symptoms (LUTS) and acute urinary retention following trans-vesical prostatectomy. The urinary retention was relieved by a suprapubic cystostomy. On cystoscopic examination, a large whitish spongiform structure in the urethra and bladder was revealed. A gentle attempt of cystoscopic removal was failed. At exploration, a retained surgical sponge was revealed and removed from the bladder. Postoperatively, the patient reported improvement of symptoms and was passing urine normally. Clinical Discussion: Vesical gossypiboma is relatively rare as very few isolated cases have been reported, and its migration through the urethra is even rarer. Patients with intravesical gossypiboma may manifest with either acute or chronic symptoms due to complications. Gossypiboma is an avoidable condition, and its occurrence can be prevented by thorough exploration of the surgical site and count of surgical materials at the end of the procedure. Conclusion Vesical gossypiboma should be considered as a differential diagnosis in patients with persistent LUTS following open bladder or prostate surgery. Open surgical removal is one of the feasible treatment options. But prevention is a preferable solution.

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“Non-Parasitic” and “Non-Iatrogenic” Chyluria: Its Diagnosis and Treatment

Surgical Case Reports ◽

10.31487/j.scr.2021.03.20 ◽

2021 ◽

pp. 1-3

Author(s):

Pier Paolo Prontera ◽

Marco Rinaldi ◽

Pier Paolo Prontera ◽

Francesco Saverio Grossi ◽

Marco Spilotros ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Retention ◽

Acute Urinary Retention ◽

Renal Colic ◽

Upper Urinary Tract ◽

Left Ureter ◽

Double J Stent ◽

Milky Urine ◽

Patient Reported ◽

Renal Hilum

Chyluria occurs in all its forms with milky urine, recurrent episodes of acute urinary retention, left renal colic and proteinuria. In non-parasitic or iatrogenic diseases, it is secondary to communicate between the cisterna system of the chyli and the lymphatics of the calyx system of the left urinary tract with a retrograde passage of a kilo and its appearance in the urine which therefore take on a milky appearance [1, 2]. Sometimes, episodically, especially after the ingestion of a high-fat meal, the quantity of kilo is so abundant that it can cause obstruction of the upper urinary tract and of the bladder, resulting in renal colic or acute urinary retention that may require their unblocking with double J stent or bladder catheter [3, 4]. After conservative attempts with a fat-free diet or with the parenteral diet, in case of their failure, surgery must be performed by performing a para-aortic and renal hilum lymphadenectomy and, in severe cases, with intraperitonealization of the kidney and left ureter. This is the case of the patient reported below and successfully treated recently with an innovative “open” surgical technique.

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Urinary Retention as the Only Symptom of Retained Surgical Sponge (Gossypiboma), 29 Years After Cesarean Procedure

Urology Case Reports ◽

10.1016/j.eucr.2016.11.022 ◽

2017 ◽

Vol 11 ◽

pp. 9-10

Author(s):

Charalampos Konstantinidis ◽

Spiridon Vlachos

Keyword(s):

Urinary Retention ◽

Surgical Sponge ◽

Retained Surgical Sponge

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Gossypiboma after Breast Augmentation

Case Reports in Surgery ◽

10.1155/2013/808624 ◽

2013 ◽

Vol 2013 ◽

pp. 1-2

Author(s):

Kira Lundin ◽

Julie E. Allen ◽

Lene Birk-Soerensen

Keyword(s):

Plastic Surgery ◽

Breast Augmentation ◽

Breast Tissue ◽

Breast Implants ◽

Private Clinic ◽

Cosmetic Result ◽

Surgical Removal ◽

Surgical Sponge ◽

Retained Surgical Sponge ◽

The Right

A 39-year-old woman was referred for removal of cosmetic breast implants and related siliconoma. After an exchange of breast implants at a private clinic a year previously, she had asymmetry of the right breast, persistent pain, and a generally unacceptable cosmetic result. An MRI had shown a well-defined area with spots of silicone-like material at the upper pole of the right breast. Surgical removal of presumed silicone-imbibed breast tissue was undertaken, and surprisingly a gossypiboma was found in its place, which had not been identified on the MRI. Gossypiboma is the condition of an accidentally retained surgical sponge. This complication is also known as a textiloma, gauzoma, or muslinoma and is well described in other surgical specialties. However, it is extremely rare after plastic surgery, and this case illustrates the need for continued attention to the surgical count of sponges and instruments.

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Perivascular epithelioid cell tumor (PEC-ome) of the prostate: Ultrasound feature in case report

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.4.393 ◽

2014 ◽

Vol 86 (4) ◽

pp. 393 ◽

Cited By ~ 1

Author(s):

Giulia Sbrollini ◽

Alessandro Conti ◽

Andrea Benedetto Galosi ◽

Vito Lacetera ◽

Rodolfo Montironi ◽

...

Keyword(s):

Urinary Retention ◽

Acute Urinary Retention ◽

Early Stage ◽

Prostate Gland ◽

Left Lung ◽

Metastatic Potential ◽

Epithelioid Cell ◽

Middle Lobe ◽

Pelvic Surgery ◽

Perivascular Epithelioid Cell

Introduction: We describe a rare tumor arising from the prostate gland: Perivascular Epithelioid Cells tumor (PEC-ome). A 54-years old was treated for acute urinary retention with alpha-blockers at presentation due to benign prostate enlargement (65 cc) with asymmetric middle lobe and regular PSA (0.92 ng/ml). After 5 months, patient developed a second acute urinary retention episode and nodules in the left lung; he was treated with transurethral resection of the prostate and left lobectomy. Results: Histological examination of prostate and lung tissue gave the same diagnosis: leiomyosarcoma with atypical morphological features and patient was observed for 4 months. Considering the uncommon diagnosis, pathological review by the uro-pathologist at our Hospital was done. Additional immunohistochemistry was done and both tumors showed similar and typical features of metastatic PEC-ome (T1b N0 M1). Therefore a new staging showed local and distant progression with prostatic mass and small lung metastasis. Three cycles of Gemcitabine and Pazopanib were administered, but 2 months later a new urinary retention occurred, despite chemotherapy. Patient referred to our Hospital for salvage pelvic surgery with lymph node dissection. Final pathological diagnosis was PECome of the prostate stage pT4 pN0 R0 M1. Conclusions: PEC-ome is a rare but rapidly invasive mesothelial tumor with early metastatic potential. When this tumors originates from the fibromuscular stroma of the prostate it mimics benign prostatic enlargement and causes LUTS. Expert pathology aided by immunoisthochemistry is the cornerstone of diagnosis. There are no pathognomonic imaging on ultrasound or symptoms suggesting the presence of PECome in early stage. A multidisciplinary approach is necessary and radical surgery should be done to treat this aggressive cancer.

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Radiation-Induced Breast Angiosarcoma

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475416631525 ◽

2016 ◽

Vol 20 (4) ◽

pp. 304-307 ◽

Cited By ~ 3

Author(s):

Cheryl Brus Peterson ◽

Solange Beauregard

Keyword(s):

Radiation Treatment ◽

Treatment Options ◽

Left Breast ◽

Diagnostic Methods ◽

Aggressive Disease ◽

Patient Reported ◽

Impact On Survival ◽

Long Term Follow Up ◽

Radiation Induced ◽

High Index Of Suspicion

Importance: Radiation-induced angiosarcoma after conservative treatment of breast cancer affects a small percentage of patients but has a significant impact on survival. Early detection requires a high index of suspicion and is important for optimal management of this aggressive disease. Observations: The patient reported here presented with radiation-induced angiosarcoma of the left breast 14 years after radiation therapy. Histopathology was positive for anti-CD31, anti-CD34, D2-40, and anti–factor VIII (von Willebrand). She underwent a total mastectomy and is still in remission 20 months later. The authors present a review of the clinical presentation, diagnostic methods, and treatment options. Conclusions: This case report demonstrates the importance of long-term follow-up and investigation of even the subtlest cutaneous changes in the breast after radiation treatment, because radiation-induced angiosarcoma is a very aggressive disease that could benefit from early diagnosis and management.

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