IntroductionMerkel cell carcinoma (MCC) is a rare cutaneous malignancy that normally occurs in sun-exposed areas of the skin. Risk factors are immundeficency and Merkel cell polyomavirus.Treatment options are surgery, radiotherapy, chemotherapy and immunotherapy in clinical trials.Case reportWe describe a case of an 80-year-old woman with ovarian metastasis of MCC six years after excision of a cutaneous MCC on the cheek.DiscussionTo our knowledge only three cases with ovarian metastasis of MCC have been described so far. Our case is the second with distant metastasis to the ovary spreading from a primary tumor in the skin of the head, in the other two cases the primary tumor was in the inguinal skin.ConculsionMCC is a highly aggressive cutaneous and mucosal malignancy with frequent recurrence, lymph node and distant metastases. There is no clear consensus how to treat metastatic disease.
Introduction: Overactive bladder syndrome is defined as urgency with or without incontinence, often with frequency and nocturia but without infection or other pathology. For the patient, overactive bladder syndrome means an essential loss of quality of life. The therapeutic concept follows a graduated, stepwise scheme. The first step consists of behavioral treatment with bladder training and pelvic floor education as well as local estrogen therapy. Following inadequate response to these measures, it is often necessary to add anti-muscarinic drugs or beta-3 agonists. In case of medical contraindication or insufficient response to pharmacologic treatment, neuromodulation, i.e. percutaneous posterior tibial nerve stimulation, should be routinely offered to overactive bladder syndrome patients. Case Report: We present the case of an 81-year-old woman with long-lasting overactive bladder syndrome without incontinence. Behavioural treatment, local estrogen and anti-muscarinic therapy were unsatisfactory, therefore, an additional treatment employing percutaneous posterior tibial nerve stimulation was implemented. Under this regimen, the symptoms dramatically improved. Conclusion: The reported overall success rate of percutaneous posterior tibial nerve stimulation in the literature ranges from 33 -71%, with success being defined as more than a 50% decrease in urgency and a 25% reduction of frequency and nocturia, respectively. There is no other therapeutic option for overactive bladder syndrome patients, that reaches similar success rates. Percutaneous posterior tibial nerve stimulation should be routinely offered to overactive bladder syndrome patients and employed as an early step in the treatment of overactive bladder syndrome, sometimes in combination with or even before the introduction of medications.
Tension-free midurethral synthetic slings are a minimal invasive treatment of stress urinary incontinence. If urinary incontinence occurs in combination with pelvic floor disorder, a combined treatment must be considered. We describe a case of sudden complete urinary incontinence 20 days after pelvic floor surgery and mid-urethral sling operation.
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