Primary Localised Amyloidosis of the Urethra: A Case Report

Primary localised amyloidosis of the urethra is a rare entity with only 50 cases reported in the literature. The deposition of fibrillary proteins can lead to a range of symptoms. Importantly, the clinical and cystoscopic features may mimic urethral malignancy (haematuria, voiding difficulties, and a palpable urethral mass), and so thorough investigation is required in order to exclude malignancy, and to identify features of generalised amyloidosis which has a poor prognosis. Once diagnosed the prognosis of localised amyloidosis is excellent, although disease recurrence is possible. We describe a case of primary localised urethral amyloidosis presenting with visible haematuria and a urethral stricture and reviewed the literature regarding management of this rare condition.

Urinary retention on an acute geriatric hospitalisation unit: prevalence, risk factors and the role of screening, an observational cohort study

Purpose Urinary retention (UR) is common in older patients. The aim of this observational cohort study was to measure the prevalence of UR in patients aged ≥ 75 years on admission to an acute geriatric hospitalisation unit and to determine which at risk group would benefit from screening. Methods Post-void residual volumes (PVR) were measured within 3 days of admission with an ultrasound bladder scan. Uni- and multivariable analysis were used to determine risk factors associated with PVR ≥ 150 and ≥ 300 millilitres. Results Ninety-four patients, mean age 84.6 years, were included. The male/female ratio was 0.7. Patients with PVR ≥ 150 (29.8%) had more urological comorbidities, symptoms of overflow incontinence, voiding difficulties, subtotal voiding, faecal impaction, urinary tract infection (UTI) and were more frequently referred because of urinary symptoms. Patients with PVR ≥ 300 lived less at home, had more urological comorbidities, dysuria, voiding difficulties, subtotal voiding, constipation, faecal impaction, UTI, detrusor relaxants, and were more frequently referred because of urinary symptoms. Voiding difficulties and referral because of urinary symptoms were independently associated with PVR ≥ 150. Not living at home, reporting subtotal voiding, constipation, and referral because of urinary symptoms were independently associated with PVR ≥ 300. Conclusion Screening for UR on admission to an acute geriatric hospitalisation unit is most indicated in patients with urinary and defaecation problems. However, because the prevalence was high, because UR was also observed in patients without these problems, and history taking may be difficult, the threshold for PVR measurement in acutely ill geriatric patients should be low. Trial registration Clinicaltrials.gov NTC04715971, January 19, 2021 (retrospectively registered).

Use of a symptom-based questionnaire to screen for the presence of significant voiding dysfunction in patients with multiple sclerosis and lower urinary tract symptoms: a pilot study

Introduction Lower urinary tract dysfunction is common in people with multiple sclerosis, leading to overactive bladder symptoms, voiding difficulties or a combination. First-line medications for overactive bladder symptoms are effective. Current guidelines recommend measuring post-void residual volume (PVR) before commencing these treatments, as they can potentially exacerbate voiding difficulties in those with significant underlying voiding dysfunction (pre-treatment PVR > 100 ml). However, facilities to do so are not readily available to all clinicians, potentially delaying effective therapy. Aims To conduct a pilot study investigating the association between lower urinary tract symptoms and PVR volume in people with multiple sclerosis using a validated questionnaire and to determine if questionnaire scores can be used to exclude a significantly elevated (> 100 ml) PVR volume. Methods Patients with multiple sclerosis referred to a tertiary hospital uro-neurology service completed the Urinary Symptom Profile questionnaire and underwent PVR measurement by bladder ultrasound. A ratio of the questionnaire low stream score/total score was calculated to standardise the relative degree of voiding symptoms compared to overall lower urinary tract symptoms. Results Of 40 patients (29 females, mean age 50 years), 30% had an elevated PVR volume. PVR volume was correlated with low stream score and ratio of low stream/total score. A cut-off of > 0.15 for low stream/total score ratio had 92% sensitivity and 71% specificity in predicting an elevated PVR volume. Conclusion A symptom-based questionnaire maybe a useful screening tool to distinguish patients in whom PVR measurement is required from those who could safely start on treatment for overactive bladder symptoms.

Study of prevalence of urinary tract infection in febrile children less than 5 years of age

Background: Fever is the most common reason for children under 5 years of age to visit the OPD. Unlike other foci of infection, only a little attention has been focused on the identification of UTI in febrile children. Quite often child receives antibiotics empirically without adequate evaluation of UTI. To determine the prevalence of UTI in all febrile children, from 2 months to 5years of age.Methods: The study included children admitted with bronchiolitis in between during the period of December 2018 to March 2019 at Department of Pediatrics, Raja Muthiah Medical College and Hospital. Totally 200 consecutive children from 2 months to 5 years admitted in the pediatric department Data related to age, sex, predisposing factors will be noted. Urine analysis and urine culture have to be done in all these patients. USG abdomen to be done in patients with culture positive UTI.Results: Among the 200 cases, the prevalence of UTI was higher among females (10%) than males (8%). Among the culture-positive cases UTI, an underlying focus of infection was present in 89% of cases and only 11% of cases did not have any foci. In this study, the % of cases with a duration of fever more than 5 days was 57, as compared to 43% in patients with fever less than 5 days. Among the 19 UTI cases, 5 of them presented with voiding difficulties and all the 5 cases had significant growth on culture. There was a significant association between UTI cases and voiding difficulties.Conclusions: Hence through this study, authors concluded that pyuria of >5 pus cells /HPF in the centrifuged sample should be considered as significant pyuria and hence further evaluation should be done in all these cases to promptly initiate antibiotic treatment and also to prevent morbidity and several long term sequelae.

Endometriosis of the conus medullaris causing cyclic radiculopathy

Intramedullary spinal cord hematomas are a rare neurosurgical pathological entity typically arising from vascular and neoplastic lesions. Endometriosis is an extremely rare cause of intramedullary spinal cord hematoma, with only 5 previously reported cases in the literature. Endometriosis is characterized by ectopic endometrial tissue, typically located in the female pelvic cavity, that causes a cyclical pain syndrome, bleeding, and infertility. In the rare case of intramedullary endometriosis of the spinal cord, symptoms include cyclical lower-extremity radiculopathies and voiding difficulties, and can acutely cause cauda equina syndrome. The authors report a case of endometriosis of the conus medullaris, the first to include radiological, intraoperative, and histopathological imaging. A brief review of the literature is also presented, with discussion including etiological theories surrounding intramedullary endometriosis.

Managing women with complex presentations: How to approach concomitant prolapse and voiding dysfunction

Concomitant pelvic organ prolapse and voiding difficulties (e.g., incontinence) can both be corrected surgically at the same time. Voiding dysfunction secondary to incontinence surgery is uncommon, but does occur even in the most experienced hands. Surgical re-intervention can correct these post-surgical voiding difficulties.

Percutaneous laser disc decompression in the treatment of detrusor-urethral dyssynergia in a female German Shepherd: a case report

A 7-year-old female, German Shepherd with urinary and faecal voiding difficulties was admitted to the clinic. The patient was subjected to neurological, ultrasonographic and radiological examinations as well as blood and urine tests. Based on clinical observations and test results, the dog was diagnosed with detrusor-urethral dyssynergia. The prescribed pharmacological treatment consisted of alpha adrenergic receptor antagonists and skeletal muscle relaxants. The patient was catheterised daily, and Foley’s catheter was temporarily inserted. Pharmacological treatment was not effective, however, and the patient was subjected to an MRI examination of the lumbosacral spine which revealed L6–L7 dyscopathy. The dog was then subjected to percutaneous laser disc decompression. Pharmacological treatment was continued, and the catheter was left in place after surgery. Active urination was restored four days after surgery despite the presence of the catheter. The catheter was subsequently removed, and pharmacological treatment was gradually discontinued. The symptoms of dyssynergia subsided completely.