Spontaneous Rupture of the Urinary Bladder 10 Years after Curative Radiotherapy

It has been reported that the rate of clinically relevant side effects following curative radiotherapy for primary carcinoma is about 3% for urologic complications. Such complications include hematuria, fibrosis, and cystitis. An extremely rare, but dangerous, medical complication following curative radiotherapy that can also be noted is spontaneous bladder perforation. We present such a case of a 27-year-old patient with spontaneous bladder perforation, who was initially misdiagnosed because of its rarity as well as unspecific clinical and laboratory findings

Anaplastic Sarcoma of the Kidney

We present a case of an extremely rare and relatively new tumor entity of the kidney, the anaplastic sarcoma. Although of unknown origin and pathogenesis, treating such a tumor as if it was anaplastic Wilms' tumor seems to be the only therapeutic solution at the present time. Newer immunohistochemical staining and molecular probes should be applied to this neoplasm in order for us to understand it nature and maximize therapy

Anaplastic Sarcoma of the Kidney

We present a case of an extremely rare and relatively new tumor entity of the kidney, the anaplastic sarcoma. Although of unknown origin and pathogenesis, treating such a tumor as if it was anaplastic Wilms' tumor seems to be the only therapeutic solution at the present time. Newer immunohistochemical staining and molecular probes should be applied to this neoplasm in order for us to understand it nature and maximize therapy

Endometriosis Involving the Ureter - The Erlangen Experience Exemplified by Two Case Reports

Einleitung: Die Endometriose ist eine gutartige Wucherung versprengter bzw. ektoper Endome− triumschleimhaut, die die histologischen Merk− male und biologischen Reaktionen der Uterus− schleimhaut beibehalten hat. Es handelt sich da− bei um Gewebe, das nicht zu selbständiger Proli− feration befähigt ist, sondern dem Einfluss von Östrogen und Progesteron unterliegt. In dieser Ar− beit werden die Krankheitsverläufe von zwei un− serer Patientinnen mit histologisch nachgewiese− ner Endometriose mit Beteiligung im Harnleiter− bereich mit Harnstauungsnieren dargestellt. Fallbericht 1: Bei einer 36−jährigen Patientin wurde im Rahmen einer Hypertonieabklärung so− nographisch eine Harnstauungsniere links diag− nostiziert. Durch unsere Gynäkologen konnte durch eine Laparoskopie histologisch eine Endo− metriose festgestellt werden. Zwei Tage nach dem laparoskopischen Nachweis von Endome− trioseherden im Darm, Douglasraum, an den Ova− rien, sowie im Bereich des terminalen Harnleiters links erfolgte die perkutane Nierenfistelanlage links, ultraschall− und radiologisch kontrolliert. Urologisch wurde nach Resektion des befallenen Ureterabschnittes eine Harnleiterneueinpflan− zung links mit Psoas−Hitch−Plastik durchgeführt. Fallbericht 2: Eine 30−jährige Patientin klagte seit Monaten über Dyspareunie, Druckschmerzen im Douglasraum, gelegentliche Defäkations− schmerzen und Kreuzschmerzen. Außerdem be− stand seit Jahren ein unerfüllter Kinderwunsch. Ein Nierenaufstau III. Grades wurde sonogra− phisch nachgewiesen. Nach stationärer Aufnah− me und entsprechender Vorbereitung erfolgte eine Woche später eine offene Laparotomie mit Adhäsiolyse des Darmes, sowie des Ovars, Salpingektomie und urologischerseits nach par− tieller Ureterresektion eine Harnleiterneuein− pflanzung in Psoas−Hitch−Technik links. Schlussfolgerung: Die Endometriose des Harntraktes ist mit 1±2% der von der Endometriose betroffenen Patientinnen eine seltene Erkrankung, wobei die Harnblase der häufigste Lokalisa− tionsort ist. Eine Endometriose mit Harnleiterbeteiligung wird oft sehr spät diagnostiziert, da asymptomatische Verläufe und die Seltenheit dieses Krankheitsbildes häufig zu einer verspäte− ten Diagnoseerhebung führen. Es sollte stets ein individuelles Therapiemanagement angestrebt werden, das in erster Linie vom Alter der Patientin, bestehendem Kinderwunsch und von der Ausdehnung des Endometrioseherdes abhängig ist.Introduction: Endometriosis is a benign prolife− ration of discarded or ectopic endometrial mucus membranes which retain the histological fea− tures and biological reactions of uterine mucus membranes. This tissue is not capable of inde− pendent proliferation but is subject to the influ− ence of estrogen progesterone. In this report we describe the clinical course of two patients with histologically proven endometriosis with partici− pation of the uteral region and uronephrosis. Case Report 1: Left−sided uronephrosis was di− agnosed in a 36−year−old female during a sono− graphic examination for hypertension. Our gy− naecologists obtained histological proof of endo− metriosis by laparoscopy. Two days after the la− paroscopic detection of foci of endometriosis in the intestine, Douglas’ pouch, ovaries as well as in the region of the left terminal ureter, a left per− cutaneous renal fistula was created under sono− graphic and radiological control. After resection of the afflicted section of the ureter, implantation of a new left ureter was performed by means of a psoas−hitch plasty. Case Report 2: A 30−year−old female presented with a months−long history of dyspareunia, pain on palpation of the Douglas’ pouch, occasional pain on bowel movements and back pain. In ad− dition she had been trying for years to become pregnant. On sonography renal congestion grade III was detected. After admission and appropriate preparation, one week later an open laparotomy with lysis of intestinal as well as uterine adhe− sions, salpingectomy and, by the urologist, partial left uteral resection with new implantation by the psoas−hitch technique. Conclusions: Endometriosis of the urinary tract is a rare occurrence affecting 1±2% of all endo− metriosis patients with the urinary bladder being the most commonly affected site. Endometriosis with involvement of the ureter is often diagnosed very late because of the rareness of this situation and its asymp− tomatic course. An individual therapy plan depending first of all on the patient’s age, desire for children, and the extent of the en− dometriosis foci should always be attempted

Surgical management of female stress urinary incontinence

Stress urinary incontinence in women is a common problem in Germany, with approx. 5 million women suffering from incontinence symptoms. These numbers are increasing, due to demographic changes; the suspected numbers are even higher. Prior to treatment, an extended diagnostic approach - including urodynamics and cystoscopy when necessary - is essential for optimal treatment selection. Primary treatment should be conservative, with pelvic floor training as an essential part of a multi-modal treatment concept. If conservative treatment fails, surgery is necessary and an increasing number of women are being treated with sub-urethral slings. The use of classical and well-known reconstructive surgeries-such as colposuspensions-is decreasing. An artificial urinary sphincter is a seldom indication in women, but a feasible option if the patient is physically and manually fit enough. The following article will summarise current diagnostic approaches and treatment options

The Prune Belly Syndrome: Urological Aspects and Long-Term Outcomes of a Rare Disease

Prune-Belly syndrome is a disorder characterized by the following triad of symptoms: deficiency of the abdominal muscles, malformations of the urinary tract and bilateral cryptorchidism. This study included a total of 16 patients. The findings included clinical characteristics, diagnostics, therapy and long-term clinical outcomes. All patients were asked to complete a questionnaire and, in some cases, were given further examination. All patients were diagnosed with congenital aplasia of the abdominal wall and a variety of urogenital malformations. Cryptorchidism was present in 11 patients (68.8%), malformations of the prostate in 3 (18.8%), urethral malformations in 8 (50%) and mega-ureter in 14 patients (87.5%). A mega-bladder was observed in 13 patients (81.3%). Distinctive renal malformations, such as renal dysplasia, in 3 patients (18.8%) and hydronephrosis in 9 patients (56.3%), respectively. Abdominoplasty was performed on 4 patients (25%). Urethral surgery was performed in 10 patients (62.5%). Seven patients (43.8%) required ureter surgery, most of which involved re-implantation of the ureter and, in some cases, additional ureter modeling. Renal surgery was performed on 5 patients. Four patients with non-functioning kidneys with hydronephrosis underwent a nephrectomy and one patient pyeloplasty. We demonstrate that successful treatment is possible even in cases of serious and complex malformations, such as those of the Prune-Belly syndrome. Treatment must be tailored to the individual patient. The severity of the renal dysplasia is the main prognostic factor

Perirenal Hematomas Induced by Extracorporeal Shock Wave Lithotripsy (ESWL). Therapeutic Management

Extracorporeal shock wave lithotripsy (ESWL) is nowadays accepted as the treatment of choice for the majority of patients with renal or proximal ureteral calculi. Although, a relatively noninvasive modality with low morbidity, minor or major complications can be noted. A relative severe complication for the patient and confusing for the treating physician is the perirenal hematoma. With review the literature and an example of perirenal hematoma induced by ESWL in a patient treated in our department, we describe its therapeutic management