Pseudomembranous Trigonitis: A Common but Underrecognized Urological Entity

Pseudomembranous trigonitis is the term used to describe squamous metaplastic changes of the bladder trigone, which affect nearly 40% of adult females. We present the characteristics of this underrecognized clinical entity and encourage further relevant research

TREM-1 expression on neutrophils and monocytes of septic patients: relation to the underlying infection and the implicated pathogen

<p>Abstract</p> <p>Background</p> <p>Current knowledge on the exact ligand causing expression of TREM-1 on neutrophils and monocytes is limited. The present study aimed at the role of underlying infection and of the causative pathogen in the expression of TREM-1 in sepsis.</p> <p>Methods</p> <p>Peripheral venous blood was sampled from 125 patients with sepsis and 88 with severe sepsis/septic shock. The causative pathogen was isolated in 91 patients. Patients were suffering from acute pyelonephritis, community-acquired pneumonia (CAP), intra-abdominal infections (IAIs), primary bacteremia and ventilator-associated pneumonia or hospital-acquired pneumonia (VAP/HAP). Blood monocytes and neutrophils were isolated. Flow cytometry was used to estimate the TREM-1 expression from septic patients.</p> <p>Results</p> <p>Within patients bearing intrabdominal infections, expression of TREM-1 was significantly lower on neutrophils and on monocytes at severe sepsis/shock than at sepsis. That was also the case for severe sepsis/shock developed in the field of VAP/HAP. Among patients who suffered infections by Gram-negative community-acquired pathogens or among patients who suffered polymicrobial infections, expression of TREM-1 on monocytes was significantly lower at the stage of severe sepsis/shock than at the stage of sepsis.</p> <p>Conclusions</p> <p>Decrease of the expression of TREM-1 on the membrane of monocytes and neutrophils upon transition from sepsis to severe sepsis/septic shock depends on the underlying type of infection and the causative pathogen.</p

Pseudomembranous trigonitis: A common but underrecognized urological entity

Pseudomembranous trigonitis is the term used to describe squamous metaplastic changes of the bladder trigone, which affect nearly 40 of adult females. We present the characteristics of this underrecognized clinical entity and encourage further relevant research. Copyright © 2010 M. Stavropoulos et al

Orthotopic bladder substitution after radical cystectomy: 5 years of experience with a novel personal modification of the ileal S pouch

Purpose: We report a 5-year experience with 52 patients who underwent radical cystoprostatectomy for bladder cancer and orthotopic bladder substitution using a novel personal modification of the S pouch. Materials and Methods: From September 1995 to December 1999, 52 men 36 to 72 years old (mean age 63) underwent bladder substitution with an S pouch. They were followed until September 2000. The pouch was constructed with a 36 cm. segment of ileum with the whole length used for the reservoir. The ureters were directly anastomosed with one above the other in the mid segment of the pouch without any antireflux procedure. Complications were documented and classified as early or up Do 3 months postoperatively and late, and further subdivided by the relationship to neobladder construction. Continence and voiding pattern were evaluated by personal interview and neobladder function was urodynamically assessed. Mean followup in our patients was 30 months. Results: The most, common of the 5 early and 9 late neobladder related complications were persistent urine leakage and reflux, respectively. There was no reflux greater than grade III in the 4 patients with reflux (5 refluxing ureters) and no functional disorders. We observed 12 early and 5 late complications unrelated to the neobladder. Open reoperation was required in 5 cases. Good or satisfactory daytime and nighttime continence was reported by 95% and 88% of our patients, respectively. By year 1 postoperatively 91% of our patients voided at an interval of 3 to 5 hours during the day. Mean maximum neobladder capacity was 672 mi. and mean post-void residual was 30 mi. by year 3 postoperatively. Two patients required self-catheterization once daily and mild hyperchloremia without acidosis developed in 2. Conclusions: The advantages of our modified S pouch are technical simplicity, substantially shorter operative time and decreased bowel length required. It is associated with an acceptable complication rate and functional parameters with subsequent patient satisfaction and good quality of life

Shockwave lithotripsy in unrecognized pregnancy: Interruption or continuation?

A 32-year-old woman underwent SWL of a 4 X 6-mm calculus in the distal third of the right ureter, receiving 2100 shocks at a maximum intensity of 18 kV. Approximately I month later, it was discovered that she had been 10 weeks pregnant at the time of SWL. She chose to continue the pregnancy and delivered a normal infant at term. We do not advocate SWL in pregnancy, but further research is mandatory to determine if this procedure can ever be performed safely during pregnancy

Precursor lesions of prostate cancer

Several morphological lesions have been proposed that may act as potential precursor lesions of prostate cancer. These are the morphologically distinct entities of focal atrophy or post-atrophic hyperplasia (PAH), atypical adenomatous hyperplasia (AAH) or adenosis, and prostatic intraepithelial neoplasia (PIN). The diagnostic criteria of low-and high-grade PIN (LGPIN and HGPIN, respectively) and of lesions suspicious for cancer (LSC) have been established. In the present review, we present the current knowledge about the precursor lesions of prostate cancer. We focus on the epidemiology, pathogenesis, clinical markers, and differential diagnosis of PIN. The similarities between HGPIN and prostate cancer are also discussed. Furthermore, potential markers and management strategies (that is, repeat biopsy, chemoprevention, radical prostatectomy, radiotherapy) are outlined along with updated recommendations. Copyright © 2007 Informa Healthcare

An overview of stress urinary incontinence treatment in women

Stress urinary incontinence (SUI) is common in women, but it is under-reported and under-treated. We review here the management of SUI in women. Pelvic floor muscle training treats SUI in the majority of female patients, whereas anti-SUI devices are not widely accepted. Duloxetine has been approved for treating SUI. Suburethral slings have revolutionized the surgical management of SUI with durable efficacy, in contrast with injectable bulking agents. © 2007, Editrice Kurtis

Insight into long-term histological, proliferative and apoptotic modifications in ileal orthotopic neobladder and conduit mucosa

Aims and background. To assess the long-term histological, apoptotic and proliferating alterations of the intestinal mucosa of ileal conduits and orthotopic neobladders. Methods. Fifty patients (46 males, 4 females), aged 52-78 years, who underwent urinary diversion with either ileal orthotopic neobladder (group ON, 20 patients) or conduit (group IC, 30 patients) from 2001 to 2005, were included in this prospective study. Ileal samples were collected during surgery (controls) and by random mucosal biopsies 6, 12, 24, 36 and 48 months later. Histological (villi height, crypt depth, eosinophil cell count), proliferation (Ki67 immunochemistry), and apoptotic (Bcl-2 immunochemistry, TUNEL) parameters were assessed. Results. During the 4-year follow-up, we recorded progressive villi area, height and crypt depth reduction, mucosa flattening, and inflammatory and eosinophilic infiltration. Villi height: crypt depth ratio showed a statistically significant difference (P &amp;lt;0.05) between the two groups from the 6th month. Dysplasia, metaplasia, and neoplasia were not observed. Bcl-2 values showed a progressive increase until 24 months in group ON and 12 months in group IC, followed by a decline thereafter. Ki-67 values showed a progressive increase after 6 months in group ON and an increase until 24 months followed by a decline thereafter in group IC. TUNEL showed two peaks, at 24 and 48 months. Conclusions. Histological adaptation was revealed in both groups, with statistically significant differences in favor of orthotopic substitution. Proliferative and apoptotic pathways are implicated as demonstrated by relevant modifications of Bcl-2, Ki-67 and TUNEL, in accord with the histological adaptation