Late presentation of a cauda equina lesion with a vulval abscess: a case report

Background Cauda equina syndrome is a rare clinical condition that requires prompt diagnosis and timely surgical decompression with postoperative rehabilitation to prevent devastating complications. Case presentation A 55-year-old Sinhalese woman presented with a vulval abscess, with a history of involuntary leakage of urine for the last 7 years. Her sexual activity has been compromised due to coital incontinence, and she had also been treated for recurrent urinary tract infections during the last 7 years. On examination, a distended bladder was found. Neurological examination revealed a saddle sensory loss of S2–S4 dermatomes. There was no sensory loss over the lower limbs. Bladder sensation was absent, but there was some degree of anal sphincter tone. Motor functions and reflexes were normal in the limbs. Magnetic resonance imaging revealed L5–S1 spondylolisthesis. Ultrasound imaging confirmed the finding of a distended bladder, in addition to bilateral hydroureters with hydronephrosis. An incision and drainage with concomitant intravenous antibiotics were started for the vulval abscess. An indwelling catheter was placed to decompress the bladder and to reduce vulval excoriations due to urine. Bilateral ureteric stenting was performed later for persistent hydronephrosis and hydroureter despite an empty bladder. Conclusion This is a tragic case that illustrates the devastating long-term sequelae that ensues if cauda equina syndrome is left undiagnosed. It reiterates the importance of prompt referral and surgical decompression.

Prenatal diagnostic and management of megacystis microcolon intestinal hypoperistalsis syndrome: A report on a rare case in Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare and the most severe form of functional intestinal obstruction in the newborn. The characteristic features of this congenital and fatal disease are abdominal distension, absent or decreased bowel peristalsis. Abdominal distension is a consequence of the distended, unobstructed urinary bladder with or without hydro nephrosis. Some previous reports have revealed that the typical antenatal sonographic findings are as follows: a greatly distended bladder, bilateral hydro nephrosis, and a normal amount of amniotic fluid; however, the antenatal diagnosis of this syndrome is occasionally difficult.

Refroflexio of the pregnant uterus. - Excessively distended bladder.-Cystitis.-Vistotomy.-Recovery.

M. S. 32 years old; was admitted to the hospital on July 30, 1891. Until now, she was in good health; mother of five healthy children; now she is again pregnant at 5-6 months. Two weeks ago, the abdomen began to grow rapidly, there were more frequent urges to defecate, pain in the abdomen, urine began to give a burning sensation.

Comparative study of perioperative morbidities of the conventional and ultrasound-guided suprapubic catheterization in the patients of urinary retention during emergency

Background: Urinary retention is one of the common urological emergencies and conventional ‘blind’ SPC frequently used comfortable as well superior procedure for patients. During conventional SPC, the distended bladder is identified by palpation or percussion without proper attention to intervening bowel segment and other structures. However, the recently published data suggests that if, ultrasound is used during SPC, and it identifies not only bladder but also intervening bowel segment which complications. Therefore, the objective of this study was to assess and compare the perioperative complications of both methods.Methods: This prospective study was conducted between years November’2017 to June’2019. Sixty patients (n=60) of urinary retention were randomized to undergo ultrasound guided or conventional SPC procedures. Patients were divided into two equal groups of 30 patients in US-SPC (Group-A) and C-SPC (Group-B). After either SPC, the patients were closely observed for development of complications.Results: Overall, the patients had mean age of 53.87+21.418 and 53.87+21.418 years in C-SPC and US-SPC group, respectively. Mean operative time and subsequent initial urine drainage were almost equal in both groups. However, in C-SPC group, 5(16.7%) patients developed complications in the form of 03 misplaced catheters outside bladder, 01 into retro pubic space and another 01 into rectum. All patients in Group-A required ultrasound guided revision of SPC compared to none in Group-B.Conclusion: Overall, the ultrasound-guided SPC (US-SPC) is safer procedure compared to conventional ‘blind’ C-SPC in relieving urinary retention in emergency, thus it should be recommended procedure whenever need arise for SPC procedure.

Congenital block vertebrae and intervertebral disc protrusion in a young cat

Case summaryA 6-month-old domestic shorthair cat was evaluated for proprioceptive ataxia of the pelvic limbs. Over 2 months, the cat became poorly ambulatory, paraparetic with proprioceptive ataxia and developed a firm, distended bladder with intermittent overflow urinary incontinence. Block vertebrae (T1–3, T4–5 and T10–11) and lordosis were identified on radiographs of the vertebral column. MRI revealed T3/4 intervertebral disc protrusion with severe extradural compression, secondary syringohydromyelia caudal to the protrusion and generalised intervertebral disc disease throughout the cervical and thoracic vertebrae. Dorsal laminectomy at T3/4 resulted in resolution of paraparesis and marked improvement in coordination and strength. Block vertebrae are usually considered an incidental finding. In this patient, angular deformation (lordosis) and adjacent segment disease probably contributed to clinically significant intervertebral disc degeneration and protrusion.Relevance and novel informationThere are few case reports in the literature of multiple congenital vertebral malformations causing neurological deficits in cats. This is the first reported case of successful surgical management of intervertebral disc protrusion, possibly secondary to block vertebrae and lordosis in a cat.

Neonate with urinary ascites but no hydronephrosis: unusual presentation of posterior urethral valves

Posterior urethral valves (PUV) are an important cause of paediatric obstructive uropathy. PUV are usually diagnosed by prenatal ultrasonography (US) revealing hydronephrosis and bladder distention. We describe a 17-day-old male infant with abdominal distention who had no hydronephrosis on prenatal US. Laboratory investigations showed serum creatinine of 12 mg/dL, hyperkalaemia and metabolic acidosis. Abdominal US showed large amount of ascites, normal-sized kidneys without hydronephrosis and incompletely distended bladder. Paracentesis revealed clear, yellow ascitic fluid with creatinine level of 27 mg/dL compatible with urinary ascites. Voiding cystourethrogram (VCUG) demonstrated PUV with a dilated posterior urethra, grade 5 right vesicoureteral reflux and a ruptured kidney fornix with peritoneal extravasation of contrast. Foley decompression resulted in normalisation of creatinine within 72 hours. Transurethral resection of PUV was performed, and a repeat VCUG showed recovery of forniceal rupture. This case illustrates an unusual presentation of a potentially life-threatening but treatable cause of urinary tract obstruction.

Accidental Insertion of a Peritoneal Dialysis Catheter in the Urinary Bladder

Percutaneous insertion of a peritoneal dialysis (PD) catheter has inherent risks of complications, more so if done “blind” (without fluoroscopy and ultrasound guidance). Despite the perceived disadvantages, there are very few reported cases of mechanical complications after PD catheter insertion. We present an 81-year-old man who underwent percutaneous insertion of dual-cuffed coiled Tenckhoff PD catheter under local anesthesia by a trained nephrologist. The procedure was uneventful, and the patient was discharged 45 min later in a stable state. A day later, he noticed a decline in the urine output. A week later at a scheduled clinic visit, upon unclamping the PD catheter, there was a sudden gush of amber colored fluid. A diagnostic CT scan confirmed the presence of PD catheter entering the abdominal cavity inferior to the umbilicus and the distal end coiled in the urinary bladder. This case illustrates the need for prophylactic Foley catheterization in individuals at high risk for a distended bladder either as a consequence of a mechanical obstruction from an enlarged prostate or due to a neurogenic bladder while undergoing “blind” percutaneous placement.

Urethral dysontogenic metaplasia in cat with bilateral renal dysplasia

This paper to describe a case of dysontogenic urethral metaplasia in a one month old mongrel feline who also had bilateral renal dysplasia. Dysontogenic metaplasia in cats are scarce and this change may be associated with renal dysplasia and/or lower urinary tract. The animal had history of abdominal enlargement since birth and dysuria, eliminating urine only dropwise. Due to the poor prognosis we opted for euthanasia. At necropsy was observed enlarged and distended bladder, reduced kidneys and dilated and tortuous ureters. The urethra was thickened, hard to cut, and histologically, was replacing the connective tissue, cartilage and endochondral ossification areas, which features dysontogenic metaplasia. Both kidneys presented primitive appearance featuring dysplasia. Dysontogenic metaplasia in urinary tract feline with renal dysplasia, has not been described.