Gross hematuria as the presentation of an inguinoscrotal hernia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Several complications have been reported with inguinal hernias. Although hematuria and flank pain, either as the presentation or as a complication of inguinal hernia, are infrequent, this condition may lead to the development of obstructive uropathy, which can have diverse manifestations.</p> <p>Case presentation</p> <p>A 71-year-old Iranian man with Persian ethnicity presented with new onset episodes of gross hematuria and left-sided flank pain. A physical examination revealed a large and non-tender inguinal hernia on his left side. An initial workup included an abdominal ultrasound, an intravenous pyelogram and cystoscopy, which showed left hydronephrosis and a bulging on the left-side of his bladder wall. On further evaluation, computed tomography confirmed that his sigmoid colon was the source of the pressure effect on his bladder, resulting in hydroureteronephrosis and hematuria. No tumoral lesion was evident. Herniorrhaphy led to the resolution of his signs and symptoms.</p> <p>Conclusion</p> <p>Our case illustrates a rare presentation of inguinal hernia responsible for gross hematuria and unilateral hydronephrosis. Urologic signs and symptoms can be caused by the content of inguinal hernias. They can also present as complications of inguinal hernias.</p

The value of 5-hydroxy indole acetic acid measurement in spot urine diagnosis of acute appendicitis

Objective: To assess the role of 5-Hydroxy Indole Acetic Acid (5-HIAA) levels in spot urine in diagnosis of acute appendicitis. Design: A prospective, controlled study. Setting: Ankara Numune Teaching and Research Hospital, Ankara, Turkey. Subject: Twenty six patients with histologically proven acute appendicitis following appendectomy were included in the study. Control group with consisted of patients prepared for hernia repair in the same duration. In the preoperative period, urine samples were collected from every patient for measurement of 5-HIAA. Results: The study group comprised 26 patients; 15 of those had high urine 5-HIAA levels, whereas 11 patients had values within normal range. None of ten control patients displayed positive test result. The test had 58% sensitivity and 48% specificity. In histopathological examination only two of ten patients with gangrenous appendicitis showed positive test result, whereas 13 of 16 patients with no histopathological gangrenous changes had high values. Conclusion: Urine 5-HIAA measurement has low sensitivity and specificity. The value of the test is even clearly lower in gangrenous appendicitis. This may be misleading in management of patients in late phase of appendicitis and in cases with perforation which is mainly responsible for morbidity. East African Medical Journal Vol.81(1) 2004: 40-4

Effects of bariatric surgery on urinary incontinence

Nurullah Bulbuller,1 Mani Habibi,1,2 Mustafa Yuksel,3 Onur Ozener,1 Mehmet Tahir Oruc,1 Osman Zekai Oner,1 Mehmet Altug Kazak1 1General Surgery Department, Antalya Training and Research Hospital, Antalya, 2General Surgery Department, Esenler Maternity and Child Health Hospital, Istanbul, 3Urology Department, Antalya Training and Research Hospital, Antalya, Turkey Introduction: Obesity is an important modifiable etiological factor associated with several diseases. There is strong evidence that urinary incontinence (UI) is positively correlated with body mass index (BMI). Aim: One of the many benefits experienced by obese patients after bariatric surgery is decrease in UI. To investigate this correlation, we aimed to examine the effects of weight loss on UI in female patients who had undergone laparoscopic sleeve gastrectomy (LSG). Materials and methods: Obese female patients (n=120), &ge;18&nbsp;years of age, and planning to undergo LSG were included in this prospective study. We administered the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and Incontinence Impact Questionnaire (IIQ-7) to the patients prior to surgery and 6&nbsp;months after the surgery. Using the collected data, we determined the incidence of UI and examined the relationship between the preoperative and postoperative BMI and UI values. Results: The mean age of the patients was 39.19 (standard deviation [SD] =9.94)&nbsp;years and the mean preoperative BMI was 46.17 (SD =5.35). Of the 120 patients, 72 (60%) complained of UI preoperatively. Among these 72 patients, 23 (31.95%) described urge incontinence, 18 (25%) stress incontinence, and 31 (43.05%) mixed-type incontinence. At 6&nbsp;months postoperatively, the percentage of excess weight loss was 70.33% (SD =14.84%). For all three UI subtypes, the 6-month postoperative ICIQ-UI-SF and IIQ-7 scores decreased significantly compared to the preoperative scores (P&lt;0.05). Conclusion: LSG results in a clinically significant improvement in most common types of UI, regardless of patient reproductive history, existence of comorbid conditions, and smoking status. Keywords: bariatric surgery, obesity, urinary incontinenc