Candida Bezoars with Urinary Tract Obstruction in Two Women without Immunocompromising Conditions

More than half of the cases of fungal infections of the urinary tract are caused by Candida sp., but occurrence of obstructive uropathy caused by mycetomas or fungus balls (urobezoars) is extremely rare. The latter are conglomerates of fungal hyphae. Diabetes mellitus, immunosuppression, chronic disease, and malignancies are known predisposing factors. Preoperative imaging is not pathognomonic; blood clots, radiolucent urinary calculi, air bubbles, and inflammatory debris can mimic urobezoars. We report on two otherwise healthy women presenting with urinary tract obstruction caused by candidal mycetomas of the renal pelvis that mimicked matrix lithiasis

Morphofunctional characterization of peripheral nerve damage and recovery in sphyngomielinase deficient mice

Mutation of the acid sphingomyelinase (ASM) gene and its reduced enzymatic activity is the main cause of the Type A Niemann-Pick disease. Recent advances demonstrated that ASM is necessary and sufficient to control the formation and release of microvesiscles containing the proinflammatory cytokine interleukin-1β (IL-1β) by glial cells [1]. Since IL-1β modulates the events caused by nerve damage and repair and seems to act as a neuro-modulator between activated glia and neurons [2], the control of its production and secretion might represent a new strategy in nerve regeneration and in the control of neuropathic pain. In this study we used a well-characterized ASM knockout mouse (ASMKO, [3]) to evaluate, through a multimodal approach, the onset and the course of the morphological and functional nerve damage and of neuropathic pain after sciatic nerve crush. Adult (1 and 5 month-old) male ASMKO and age-matched wild-type (WT) mice underwent sciatic nerve crush lesion. Nerve conduction velocity (NCV), walking track analysis followed by ultra-structural and morphometric analysis of sciatic nerves were performed to evaluate the features of nerve damage. Thermal (Plantar test) and mechanical sensitivity (Dynamic Plantar Aesthesiometer apparatus) were used to measure the severity of neuropathic pain. Moreover, the rotarod test completed the analysis as an indicator of motor impairment. One or two months after the nerve crush motor functional recovery was similar in WT and KO mice and the NCV measures performed in the sciatic nerve demonstrated a moderate and progressive improvement of nerve function. The results of the morphological examination confirmed the expected course of nerve recovery, but also demonstrated defective nerve regeneration, particularly evident in older, but already present in younger ASMKO mice. Behavioral tests suggested that the mutated phenotype in ASMKO might have an effect on the onset and development of mechanical and thermal hyperalgesia after nerve crush in both 1 - month and 5 - months - old groups. In conclusion, these data suggest a possible role for ASM-related microvesicles in nerve regeneration and suggest that targeting the IL-1β production and release may represent a new therapeutic strategy for the treatment of nerve damage and neuropathic pain

Pseudodiverticula of the ureter: radiologic and histologic findings

A 70-year-old man with previous history of TUR-BT presented positive urinary cytology at one year follow-up. Cystoscopy with bladder mapping was negative, and IVP revealed multiple outpouchings of the right upper ureter without hydronephrosis. Ureteroscopy failed because of an underlying stricture. Surgical excision of the strictured segment and of 2.5 cm of cranial ureter was performed. Histopathology demonstrated focal hyperplasia of the urothelium with outpouchings involving only the mucosa, compatible with the diagnosis of pseudodiverticula

Ureteral Reimplantation with Psoas Bladder Hitch in Adults: A Contemporary Series with Long-Term Followup

We retrospectively evaluated our experience with ureteral reimplantation and psoas bladder hitch to restore urinary tract continuity in patients with lower ureteral defects, since long-term data on the outcomes of this procedure have been relatively scarce in the last two decades. The procedure was performed in 24 patients (7 male, 17 female) with a mean age of 54.6 years. The mean ureteral defect length was 4.8 cm (range 3–10), the ureterovesical anastomosis was performed with simplified split-cuff technique in 18 patients, submucosal tunnel in 2, and direct anastomosis without antireflux technique in 2. Mean followup was 53 months (range 12–125), and there were no reinterventions. Postoperative renal imaging was normal in 22 cases (91.6%) and revealed decreased kidney size in 2, 3 patients presented intermittent flank pain, and 5 had sporadic episodes of lower tract UTI but no one pyelonephritis. Psoas hitch ureteral reimplantation can be successfully used for bridging defects of the lower ureter up to 10 cm in length in difficult clinical situations. It is relatively simple to perform, compared to other procedures of ureteral reconstruction, and it provides adequate protection of the upper urinary tract

Orgasm-Associated Incontinence (Climacturia) after Bladder Neck-Sparing Radical Prostatectomy: Clinical and Video-Urodynamic Evaluation

Introduction.  Orgasm-Associated Incontinence (OAI) or climacturia has been observed in male patients maintaining sexual potency after radical prostatectomy and cystectomy. Aim.  We investigated the incidence and video-urodynamic aspects of this event in continent and potent patients after bladder neck-sparing (BNS) radical prostatectomy (RP). Main Outcome Measure.  Comparing functional and morphological aspects between climacturic and non-climacturic patients to identify a possible explanation of this unusual kind of leakage that could seriously impact the sexual life after surgery. Methods.  In a pool of 84 men, potent and continent at least 1 year after BNS RP, 24 (28.6%) reported climacturia and 7 agreed to undergo video-urodynamic evaluation (group 1), which was performed also in 5 controls (group 2). Those 12 men were also evaluated with 24-hour pad test, 5-item International Index of Erectile Function and International Prostate Symptom Score questionnaires. Results.  Functional urethral length (FUL) was significantly lower in the climacturia group (P = 0.02) and time to continence recovery was significantly longer (P = 0.05). No other significant differences were found between the two groups. The radiological appearance of the vesicourethral junction at voiding cystourethrography was similar. Conclusions.  To the best of our knowledge, this is the first functional and morphological evaluation of climacturia after RP. In our experience, this event is indirectly associated with a reduced FUL in the sphincter area, although both patients and controls were continent during daily activities. BNS technique seems to reduce time to continence recovery, although climacturic patients need longer time than control patients. Since in our series no rigidity of the vesicourethral anastomosis was radiographically evident, we believe that differences in FUL could explain OAI. Anatomical difference in membranous urethra length could explain the occurrence of this symptom in patients treated with the same surgical technique