The urachus is the remnant of the cloaca, which in adults attaches the bladder dome to the umbilicus. After birth it obliterates and presents as the midline umbilical ligament. Patent urachal anomalies are usually detected in childhood. In adults they occur very rarely and the presentation and diagnosis may be occasionally challenging. We present and discuss the case of an infected urachal cyst found in a 30–year–old adult.
Despite complete resection, non-muscle invasive bladder cancers tend to recur. Therefore, their risk stratification was implemented to select adjuvant therapy. Immediate intravesical chemotherapeutic instillations were shown to decrease the risk of recurrence in those with low-risk disease. The purpose of the study was to determine the role of endoscopic assessment in the management of patients subjected to transurethral resection of the bladder tumour (TURBT). In 262 patients submitted to TURBT due to primary bladder tumour, the size and the number of the lesion(s) were noted and the stage as well as the grade of the tumour(s) were typed. The individual features were then scored according to the European Organisation of Research and Treatment of Cancer 'Bladder Calculator' and the lesions were classified into the low, intermediate and high risk of recurrence group. Clinical evaluation was then compared with pathological report and final triage. Based on the clinical data, 95 (36.25%), 105 (40.07%) and 3 (1.14%) patients were endoscopically assigned to the groups of low, intermediate and high risk of recurrence respectively. After pathological report, correct risk stratification was confirmed in 86 (90.5%), 95 (90.5%) and 3 (100%) patients respectively. Endoscopic assessment of bladder cancers allows to accurately establish the risk of recurrence and may facilitate implementation of adjuvant therapy before histological evaluation.
IntroductionIn some patients submitted to transurethral resection of the prostatic (TURP) or prostatectomy (OAE) due to benign prostate hyperplasia (BPH), pathological evaluations (PE) revealed coexistence of prostate cancer (PCa) and BPH. The aim of the study is to evaluate the incidence of PCa diagnosed incidentally in prostate specimens taken during BPH surgery, to assess the need of routine PE and to define the group of patients in whom PE could be abandoned without the risk of omitting clinically significant PCa.Material and methods968 consecutive men were subjected to surgical treatment due to BPH in Jan. 2004–Sep. 2010.Results823 (85%) underwent TURP and 145 (15%) OAE. Incidental (Inc) PCa was diagnosed in 34(3.5%) pts. T1a and T1b stages were determined in 19 (2%) and 15 (1.5%) cases. Preoperative prostate biopsy due to abnormal prostate specific antigen (PSA) or digital rectal exam (DRE) was performed in 85 (8.8%) pts. Of PCa pts, 7 (20.58%) had undergone a cancer negative biopsy preoperatively. In BPH pts, 78 (8.35%) had undergone a prostate biopsy previously (p <0.01). Univariate and logit regression analyses had not revealed any correlations between age, Pv, serum PSA and frequency of IncPCa. The difference in rate of PCa diagnosed in patients with PSAD ≥0.15 and <0.15 was 8 pts (14.04%) and 20 pts (4.05%), respectively (p <0.001). Gls in those pts was >6 only in 4 cases.ConclusionsDespite the fact of low PCa detection rate observed in our study, this condition was clinically relevant in 15 (1.5%) subjects. It is difficult to establish any cut off values of pts’ age, Pv, serum PSA level suggestive of negligible risk for prostate cancer.
Suprapubic catheterisation is generally considered a safe procedure. It can, however, be associated with complications including haematuria. It is usually self-limiting and easily treated with non-surgical measures but at times formal treatment in the operating room may be required. We present an endoscopic management of bladder tamponade through a percutaneous approach in a 21-year-old man with the fibrotic defect completely occluding his posterior urethra preventing cystoscopic clot evacuation. To our knowledge, this is the first reported case of minimally invasive treatment of bladder tamponade using a suprapubic access. We believe this challenging case will serve as an aid to management of similar episodes.
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