Multiple urinary bladder calculi: a rare cause of irreducible uterovaginal prolapse

A case of irreducible prolapse with multiple bladder calculi in a 65-years-old multiparous, postmenopausal woman is reported. Inability to walk, constipation and urinary incontinence were her primary complaints. Routine ultrasound of the abdomen and pelvis failed to reveal multiple vesical calculi as the prolapse was lying outside the pelvis. However, targeted plain X-ray of the prolapsed mass showed multiple vesical calculi. The patient was managed with single-stage vaginal hysterectomy and laparotomy. First vaginal hysterectomy was done then prolapsed cystocele was reduced and extraperitoneal vesicolithotomy done. Currently, the patient is relieved of all symptoms. Management of an irreducible procidentia and a hard mass in the anterior compartment, as in this case, can be challenging and requires a diligent effort to confirm the diagnosis and to execute the appropriate surgical protocol to achieve optimal outcome with minimal intra- and post-operative complications.

Retrospective Analysis of Lower Urinary Tract Disorders in Dogs: Study of Five Years

Background: The data pertaining to the lower urinary tract disorders in dogs in India is very merge. This retrospective analysis presents a retrospective analysis of incidence of affections of lower urinary tract in dogs. Methods: The cases of different affections of lower urinary tract presented at the Veterinary Clinical Complex, Veterinary College, Anand Agricultural University, Anand during April-2012 to March-2017 were screened and detailed information regarding age, sex and breed were collected and analysed to calculate percentage of incidence of different affections of lower urinary tract viz., surgical affections and non-surgical affection. Conclusions: Total 24319 cases of lower urinary tract affections in dogs were registered. Among them 5854 (24.07 %) surgical cases comprising urolithiasis (81, 76.42 %), bladder neoplasia (25, 23.58 %) and 18465 (75.93 %) non-surgical affections with cystitis (176, 0.95 %) cases. The highest incidence of urolithiasis was 25.93 per cent in the year 2014-15 and in 7 to 9 years aged dogs (35.80 %). The sex wise per cent incidence was higher in male (72.84) than female (27.16). The urinary bladder calculi was the highest (72.84 %) followed by the urethra (16.05 %) and both the locations (11.11 %). The year wise highest per cent incidence of cystitis was recorded for the year 2015-16 (52.27). The age wise per cent incidence of cystitis was equally higher 28.98 in the age groups of 7 to 9 and 10 to 12 years, each. The year wise the highest per cent incidence of neoplasia of urinary bladder (TCC) in dogs was 52.00 for the year 2015-2016. The age wise percent incidence of neoplasia of urinary bladder was the highest in 7 to 9 years age groups (36.00). The sex wise per cent incidence for neoplasia in urinary bladder was higher in male (64.00) than female (36.00). The breed wise highest per cent incidence of urolithiasis was in Pomeranian (25.93), cystitis in Pug (28.41) and neoplasia of bladder (TCC) Labrador and Pug (20.00, each).

Long term Urological complications in patients with Spinal cord injury

<p><strong>Introduction: </strong>Neurogenic bladder (NGB) is common in daily urological practice; however, information on types of urological complications encountered in army and veterans are not under strict surveillance and little is known to them about the best way to manage the condition. This observational study aimed to determine the types of urological complications encountered in regular soldiers and veterans with traumatic spinal cord injury (SCI) with NGB, and the usage of bladder management programs to deal with NGB.</p><p class="Default"><strong>Methods: </strong>We retrospectively reviewed the charts and records of interviewed patients with SCI in our urology clinic. Demographic data collected included: age, gender, mode of injury and level of spinal injury. Also noted were episodes of urinary tract infection (UTI), renal lesions, and bladder program followed.</p><p class="Default"><strong>Results: </strong>The mean age of our study sample (N= 63) was 40± 10.8 years and all were male. Age at onset of injury was 33.8 ± 16.6 years and duration since SCI insult was 90.6 ± 54 months. Symptomatic urinary tract infection (75%), chronic cystitis (53.3%), hydro-nephrosis (36.5%) and urinary bladder calculi (33.3%) were the common urological lesion observed. Indwelling Foley’s catheterization methods of urinary bladder management in 54% study population where urinary tract infection is more common (p&lt;0.05).</p><p class="Default"><strong>Conclusion: </strong>Urinary tract infection, hydro-nephrosis and Urinary bladder calculi were the most common urological complications encountered in army and veterans with NGB. Indwelling Foley’s catheter was the most frequently used bladder management program with the higher risk for UTI.</p><p><strong>Key words:</strong> Neurogenic bladder, Spinal cord injury, Urinary tract infection, Nepal, Army</p>

Long term Urological complications in patients with Spinal cord injury

Introduction: Neurogenic bladder (NGB) is common in daily urological practice; however, information on types of urological complications encountered in army and veterans are not under strict surveillance and little is known to them about the best way to manage the condition. This observational study aimed to determine the types of urological complications encountered in regular soldiers and veterans with traumatic spinal cord injury (SCI) with NGB, and the usage of bladder management programs to deal with NGB.Methods: We retrospectively reviewed the charts and records of interviewed patients with SCI in our urology clinic. Demographic data collected included: age, gender, mode of injury and level of spinal injury. Also noted were episodes of urinary tract infection (UTI), renal lesions, and bladder program followed.Results: The mean age of our study sample (N= 63) was 40± 10.8 years and all were male. Age at onset of injury was 33.8 ± 16.6 years and duration since SCI insult was 90.6 ± 54 months. Symptomatic urinary tract infection (75%), chronic cystitis (53.3%), hydro-nephrosis (36.5%) and urinary bladder calculi (33.3%) were the common urological lesion observed. Indwelling Foley’s catheterization methods of urinary bladder management in 54% study population where urinary tract infection is more common (p<0.05).Conclusion: Urinary tract infection, hydro-nephrosis and Urinary bladder calculi were the most common urological complications encountered in army and veterans with NGB. Indwelling Foley’s catheter was the most frequently used bladder management program with the higher risk for UTI.

Effects of dietary DHA and α-tocopherol on bone development, early mineralisation and oxidative stress in Sparus aurata (Linnaeus, 1758) larvae

DHA deficiency has been related to skeletal malformations in fish, but high DHA levels have produced controversial results that could relate to the oxidative status of fish tissues in the different reports. In the present study, gilthead seabream (Sparus aurata) larvae were fed deficient, adequate or high DHA levels, or high DHA levels supplemented with the antioxidant α-tocopherol. Larvae fed deficient DHA levels tended to be smaller, and showed the highest incidence of urinary bladder calculi, lordosis and kyphosis and the lowest number of mineralised vertebrae for any given size class. Elevation of dietary DHA increased larval growth and significantly enhanced the expression of the insulin-like growth factor 1 (IGF-1) gene. However, a DHA level increase up to 5 % raised the degree of lipid oxidation in larval tissues and deformities in cranial endochondral bones and in axial skeletal haemal and neural arches. The increase in dietary α-tocopherol supplementation in high-DHA feeds reduced again the occurrence of skeletal deformities. Moreover, the expression of genes coding for specific antioxidants such as catalase, superoxide dismutase or glutathione peroxidase, which neutralised reactive oxygen substances formed by increased dietary DHA, was significantly decreased in larvae fed high α-tocopherol levels. These results denoted the importance of DHA for early bone formation and mineralisation. Low dietary DHA levels delay early mineralisation and increase the risk of cranial and axial skeletal deformities. Excessive DHA levels, without an adequate balance of antioxidant nutrients, increase the production of free radicals damaging cartilaginous structures before bone formation.

A unusual case of 356 vesical calculii

Multiple vesical calculi are rarely seen in urological practice. Males are affected more than the females. Vesical calculi are usually secondary to bladder outlet obstruction. These patients present with recurrent urinary tract infection, haematuria or with retention of urine. We report a 43 years male patient who presented with acute urinary retention. He had history of trauma over perineal region three years back following which he had recurrent urinary tract infection and thinning of stream. USG abdomen revealed normal upper urinary tract with echogenic debris in partially filled urinary bladder. Renal function test was with in normal limit. Per urethral catheterization failed and over antibiotic cover, patient was posted for cystourethroscopy followed by suprapubic cystostomy under spinal anaesthesia. Membranous urethral stricture found during urethroscopy could be managed by optical internal urethrotomy. On cystoscopy whole of bladder was filled with thick pus like material with multiple large urinary bladder calculi. Open cystolithotomy was done and we were surprised to see 356 stones of various size and shape after removal. Patient made uneventful recovery and discharged after 12 days of hospital stay. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 44-47 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6825