Spontaneous bladder rupture is a rare condition. Inflammation and chronic infection are the main contributing factors. Perforation secondary to a bladder tumor is much more rare and it poses a real diagnostic and therapeutic problems. We report a rare case of an elderly patient of 50 years old man chronic smoker of about (40 packs per year) with a history of recurrent low urinary tract infections, a trans-urethral bladder tumor resection on 13 June 2019. Endoscopic exploration: large infiltrating tumor at the level of the posterior and lateral wall with histopathological study confirming transitional cell carcinoma (urothelial carcinoma) infiltrating the detrusor muscle classified PT2 high grade. The patient received 8 sessions of radiotherapy and 5 sessions of chemotherapy. Admitted for bladder tumor complicated with acute peritonitis. The patient had consulted at the emergency department for an acute abdomen, in which the clinical examination found a conscious patient, slightly discolored conjunctiva, febrile at 38°C with diffusely abdominal pain, tensing abdominal and a pain of pouch of Douglas by rectal examination. Laboratory result findings a hyperleukocytosis of 15000 elements/mm3, CRP at 35 mg/l and renal insufficiency with estimation of the glomerular filtration flow rate (GFR):18 ml/min/1,73 m2. The abdomino-pelvic ultrasound shows a peritoneal effusion of a little abundance. Abdomino-pelvic CT scan was requested, which had shown a pneumo-peritoneum with bladder perforation. The patient was urgently taken to the emergency room for an exploratory laparotomy with an extensive peritoneal lavage and suture of the bladder wound after removal of all necrotic margins with urinary diversion by bladder catheterisation. A thoraco-abdomino-pelvic scan was performed later and showed pulmonary and hepatic metastases of a secondary origin indicating a palliative treatment.
Spontaneous urinary bladder rupture is a rare emergency which can may be misdiagnosed as gastrointestinal tract perforation. It should be suspected in patients with acute abdomen with a history of bladder tumor.
Introduction: ChRCC is an uncommon type of renal carcinoma classified into typical and the less met eosinophilic variant. The latter is likely to be mistaken for other renal eosinophilic tumors, needing an extended immunohistochemical investigation, in order to exclude other oncocytic renal tumors. XGP is an unusual benign condition which may mimic renal cell carcinoma grossly and microscopically, being a rare chronic inflammatory disorder forming masses in the renal parenchyma.In this report we present a rare case of coexisting ChRCC and XGP in the same kidney.
Case Presentation: A 51-year-old woman presented at the emergency unit with history of upper urinary tract infections, complaining about urinary frequency, and loin pain. An abdominal CT scan revealed lesion near the renal pelvis of the left kidney and the patient underwent left nephrectomy on a regular basis. The specimen we received included a brown and partially yellow tumor. The microscopical examination of the brown areas revealed sheets of small tumor cells with eosinophilic cytoplasm and wrinkled irregular nuclei. Microscopy of the yellow-colored areas revealed replacement of the renal parenchyma by an inflammatory infiltrate composed mainly foamy or pigmented –laden macrophages and rare giant cells, extending into the tumor-free renal parenchyma and the pelvic fat. These findings led us to the diagnosis of ChRCC with coexisting XGP.
Conclusions: Since both of these entities affecting the kidney are uncommon and they rarely coexist in the same kidney, the correct clinical and histological assessment is important forthe selection of proper treatment strategy
Dichlorvos (2, 2-Dichlorovinyl Dimethyl Phosphate also known as DDVP) is an an organophosphate pesticide/ insecticide having oncogenic, genotoxic, neurotoxic and reproductive toxicity effects on the body. Elaeis guinensis (Palm oil) is an edible vegetable oil derived from the mesocarp ( reddish pulp) of fruit of the oil with antioxidant properties, beta-carotene content with highly saturated vegetable fats and is semi-solid at room temperature. This study was carried out to investigate the effects of oral administration of Red Palm Oil (RPO) on Dichlorvos (DDVP) induced testicular toxicity and sperm parameters in male albino rats. Concentration of 1ml of DDVP was diluted in 1000mls of distilled water and kept in a bottle for 3 days. 2 mls of red palm oil, 2 mls of red palm oil plus 1 ml of diluted DDVP, 1ml of diluted DDVP and 1 ml ordinary water were administered orally for 14 days respectively. Sperm parameters carried out were sperm count, motility, morphology and testicular histology analysis. The result obtained showed that DDVP administration significantly decrease sperm count, motility and morphological analysis (p<0.05). There is no significant difference in the value obtained for RPO induced rats in sperm count but significantly decrease in sperm motility and morphological analysis when compared with the value of the control (p<0.05). However, the group administered with RPO + DDVP shows significant increase in sperm count only. RPO histological analysis shows increase and well-formed seminiferous tubules with increase spermatogenic cells while DDVP shows laminar vacuolation, cellular degeneration and disruptions of seminiferous tubules. The group administered with RPO + DDVP shows an improving spermatogenic cells and normal seminiferous tubules. Therefore, this study establishes that RPO could offer positive protection against DDVP induced testicular damages.
Objectives: To compare the efficacy of silodosin (8 mg) vs tamsulosin (0.4 mg), as a medical expulsive therapy (MET), in the management of distal ureteric Calculi (DUC) in terms of stone clearance rate and stone expulsion time.
Patients and Methods: A prospective randomised study was conducted on 130 patients, aged more than 18 years, who had unilateral DUS less than 1 cm. Patients were divided into two groups. Group A received silodosin (8 mg) and Group B received tamsulosin (0.4 mg) daily for 1 month. The patients were followed-up by urine analysis & serum creatinine. Kidney ureter bladder x-ray (KUB) (for detection of the stone size and site), Pelvi-abdominal ultrasound (U/S) (for diagnosis & monitoring of the degree of hydronephrosis), Non contrast spiral CT abdomen & pelvis (NCCT): for detection of site, size and density of the stone and detection of degree of hydronephrosis.
Results: There was a significantly higher stone clearance rate of 88.3% in Group A vs 68.3% in Group B. Group also showed a significant advantage for stone expulsion time but as regard analgesic use no significant difference between both groups.
No severe complications were recorded during the treatment period. An ejaculation was recorded in 8 and 1 patients in Groups A and B, respectively. However, complication as headache hypotension are more common in group B, 4: 13 in group A and group B respectively.
Conclusion: Our data showed that silodosin is more effective than tamsulosin in the management of DUC for stone clearance rates and stone expulsion times. A multicenter study on larger scale is needed to confirm the efficacy and safety of silodosin.
Background: Benign prostatic hyperplasia (BPH) is a highly prevalent and a very common disease in elderly men. LUTS secondary to BPH increases with age and has a negative impact on patient’s quality of life. LUTS associated with BPH has variety of interventional treatment options like medical management and surgical management, where α1 blockers are tried as first line either alone or in combination with 5-α reductase inhibitors. The aim of our study is to compare the therapeutic efficacy of silodosin with tadalafil over a period of 4 weeks.
Methods: A prospective, observational, hospital based study. A total of 136 patients were involved in this study. 68 patients received silodosin 8 mg once daily and 68 patients received tadalafil 5 mg once daily as decided by the Urologist . At the end of 4th week the therapeutic efficacy of both the drugs were assessed by IPSS, IPSS QoL index score and OABSS. Adverse drug reaction in each group were also noted.
Results: Both silodosin and tadalafil were statistically significant in decreasing total IPSS, IPSS QoL index score and total OABSS at end of 4th week. But silodosin produced statistically significant reduction in total IPSS and IPSS QoL index score when compared to tadalafil. Silodosin produced numerically greater but statistically not significant reduction in total OABSS when compared to tadalafil. Incidence of adverse effects were more in silodosin group.
Conclusion: In our study we noted that both silodosin and tadalafil were efficacious in treating LUTS associated with BPH but silodosin was superior to tadalafil. Tadalafil is efficacious in patients with concomitant ED.