Solitary Bladder Fibrous Tumor: A Case Report

The solitary fibrous tumor is an infrequent neoplasm of mesenchymal origin, mainly pleural, exceptionally urogenital. Our patient is 71 years old with no specific history who was presented to the emergency room for acute retention of urine relieved by a bladder catheter. An Uroscanner showed a thickening of the bladder wall which prompted the medical staff to perform a RTUV whose histological and immunohistochemical study confirmed the diagnosis of a solitary fibrous tumor of the bladder. Solitary fibrous tumors remain slow-growing neoplasms regardless of their site. The prognosis and aggressiveness are difficult to specify. Recurrences, locoregional extension and distant metastases can be seen in 10 to 20% of cases.

Ultrasonographic Assessment of Retroverted Gravid Uterus and First Trimester Pregnancy loss of women in a semi-urban area of Dhaka, Bangladesh

Ultrasonography is a safe and effective method of diagnosing early pregnancy and determining the position of the gravid uterus. In our study, 2080 pregnant women with amenorrhea for three months and a positive pregnancy test were chosen. The study was conducted in the Radiology & Imaging department of Failaria & General Hospital from Jan 2016 to Dec 2019. Descriptive statistics were used to compute percentages and averages. Results were presented in tables and charts and expressed as percentages/proportions, means and average. The objective of our study is to investigate the Sonographic findings of first trimester pregnancies detecting the retroverted gravid uterus, normal, abnormal and complicated pregnancies. In the present study out of 2080 pregnancies, we found uterus retroverted in about 7% of women and only one case of acute retention of urine due to retroverted gravid uterus. Here, the majority of pregnant women were 20-24 years of age, which is 980 (47.12%) and 150 (7.21%) women pregnant at the age of over 35 years. In our study, 190 (9.13%) of the 2080 pregnancies with sonographic diagnosis were fetal losses. The diagnosis of early normal intrauterine pregnancy (IUP) was 1890 (90.87%), Incomplete abortion 95 (4.57%), Missed abortion 35 (1.68%), Blighted ovum 39 (1.88%), ectopic pregnancy 14 (0.67%) and Hydatiform mole 7 (0.34%) cases. If urinary retention due to retroverted gravid uterus, abnormal and complicated pregnancies are diagnosed early and treated properly, it can reduce maternal morbidity and mortality.

Current process and outcomes of the surgical management of LUTS due to benign prostatic enlargement: how consistent are we? – results from the multi-institutional audit of surgical management of BPE (AuSuM BPE) in the United Kingdom

Objective In view of changing landscape of surgical treatment for LUTS secondary to BPE, this audit was undertaken to assess key aspects of the processes and outcomes of the current interventional treatments for BPE, across different units in the UK. Materials and method A multi-institutional snapshot audit was conducted for patients undergoing interventions for LUTS/BPE over 8-week period. Using Delphi process two-part proforma was designed to capture data. Results 529 patients were included across 20 NHS trusts in England and Wales. Median age was 73 years. Indications for surgery were acute retention (47%) and LUTS (45%). 80% of patients had prior medical therapy. TURP formed the commonest procedure. 27% patients had <23 hour hospital stay. Immediate (21%) and delayed (18%) complications were Clavien-Dindo <2 category. High proportion of patients reported residual symptoms. Type and indication of surgery were significant predictor of complications, length of stay and failure of TWOC outcomes, on multivariate analyses. There were variations in departmental processes, 50% centres used PROMs. Conclusion Monopolar TURP still remains the commonest intervention for BPE. Most departments are adopting newer technologies. The audit identified opportunities for development of consistent, effective and patient centric practices as well as need for large-scale focused studies.

Huge abdominal mass with hematocolpometra due to imperforate hymen: an unusual clinical presentation

The imperforated hymen is one of the commonest genital tract malformations usually present with cyclic abdominal pain and an obstructive pelvic mass at post-pubertal age. The unusual pre­sentations are delayed menarche with obstructive symptoms rarely acute retention of urine, te­nesmus, and constipation. We report an unusual case of 12- year old girl with a huge mass in the lower abdomen examination revealed imperforate hymen at early pubertal age. Further investigation of Magnetic Resonance Imaging (MRI) confirmed hematocolpometra. Then, she underwent simple hymenotomy and drainage of collected menstrual blood from the genital tract. She recovered well during the postoperative periods. We conformed normal menstrual flow at her first follow-up. In conclusion, Imperforate hymen at peripubertal age with an unusual huge abdominopelvic mass concerns further imaging to assure the best outcome.

LEIOMYOMA OF URINARY BLADDER A RARE ENTITY: SERIES OF 3 CASES AND REVIEW OF LITERATURE

Introduction: Leiomyoma of urinary bladder is a rare entity and comprises 0.43% of all bladder tumors. Here we present our series of 3 cases and the related review of literature.Methods: 3 cases of bladder leiomyoma presented over a period of 16 months in Osmania Medical College and Hospital. Detailed history was taken, physical examination, routine blood, urine and radiological investigations were done. Patients were treated by Trensurethral Resection (TUR) of the mass and histopathological analysis with Immunohistochemistry was done for all cases.Results: All 3 cases were females with mean age of 31.6 years. All cases were endovesical type, mass near bladder neck and presented with obstructive symptoms. Two cases presented with acute retention of urine. Radiological investigations in all patients suggested a possibility of leiomyoma and all cases had reduced urinary flow rates. Histopathology confirmed the diagnosis tin all cases. No recurrence was found at one year of follow up.Conclusion: Leiomyoma of urinary bladder is a rare disorder which frequently occurs in middle aged females. Symptoms are related to its size and location, diagnosis is confirmed by histopathological analysis. Treatment is by surgery (mainly TUR). Prognosis of the disease is excellent.

OHVIRA Syndrome: A Case Report

OHVIRA syndrome or Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly of female urogenital tract which is represented by the triad of uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis. This rare variant of Müllerian duct anomalies represent failure of vertical and the lateral fusion of Müllerian ducts around 9 weeks of gestation. OHVIRA syndrome comprises about 2-3% of Müllerian abnormalities. A 13 years old girl got admission in FMCH on 15.3.2018 with lower abdominal pain and acute retention of urine. Her menarche was established 6 months back with regular cycle and associated with dysmenorrhoea. Imaging studies revealed uterine didelphys, highly dilated cervix with hematocolpos and absence of right kidney. The vaginal septum was excised. The patient recovered fully and was under follow up for 6 months. There was no evidence of further outflow tract obstruction. Faridpur Med. Coll. J. Jan 2019;14(1): 54-56

Isolated Fungal Balls in Urinary Bladder Presenting as Acute Retention of Urine

A 52-year-old male presented to surgery emergency with acute retention of urine. Patient was relieved in the emergency setting by catheterization and bladder irrigation. Urine was sterile; however, microscopy revealed field full of RBCs (>50/high-power field) and pus cells (>20/hpf). Cystoscopy revealed fungal balls in the urinary bladder which upon histopathological examination showed Aspergillus species. Patient was managed with systemic voriconazole and bladder wash with diluted povidone iodine. Predisposing factors diabetes mellitus and benign prostatic hyperplasia were medically managed, and patient recovered well. This case stresses the importance of considering isolated fungal urinary infections in predisposed individuals.

Homoeopathic treatment leading to a unique response in a patient with renal cell carcinoma

A 45-year-old male patient presented with bilateral solid renal mass probably renal cell carcinoma (RCC). After initial treatment, the patient got symptomatic relief from pain in flanks, acute retention of urine and hematuria. The patient initially declined repeated investigations but agreed for an ultrasound after two years of treatment; the result showed reduction in size of the mass. The urea, creatinine and hemoglobin percentage were normal and reported a normal blood pressure. The quality of life was maintained without the conventional surgery, radiotherapy, chemotherapy, or immunotherapy. While this case provides evidence of positive outcomes for homeopathic therapy, more studies are required in a hospital setting to establish the real extent to which this therapy may be employed.