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The Phantom Urine: An Unexpected Finding during a Routine Cesarean Section  [PDF]
Maria Pagnozza,Chahin Achtari,Jean-Yves Meuwly,David Baud
Case Reports in Obstetrics and Gynecology , 2014, DOI: 10.1155/2014/575032
Abstract: We present here an atypical finding during an elective repeat cesarean section. Despite urine flow through an indwelling bladder catheter, bladder remains distended during the whole procedure. Unexpected anatomical variations and malformations can make routine surgery challenging. Urinary tract anomalies should be suspected in cases of unexpected difficult bladder catheterization. 1. Introduction Maternal malformation can be diagnosed during pregnancy with ultrasound imaging. However, most of them remain undiagnosed or diagnosed unexpectedly during routine surgery. We present here a challenging repeat cesarean section with an unusual urinary finding. 2. Case Report A 36-year-old G3P2 patient with a history of two previous caesarean sections was admitted for an elective repeat cesarean section at 39 weeks of gestation. The routine preprocedure preparation was uneventful and an indwelling bladder catheter was placed without difficulty. Upon peritoneal entry, the bladder was noted to be significantly distended despite the fact that urine was confirmed in the urinary drainage bag. In an attempt to empty the bladder, a new 12?G Foley catheter was placed, followed by a rigid silicone catheter, but the bladder remained distended. In order to have a better view of the pelvic organs, fetal extraction and uterotomy closure were decided. Persistence of bladder distension might have resulted from a urinary tract injury at initial catheterization. To investigate this hypothesis, 400?mL of methylene blue was injected through the urinary catheter. The bladder volume did not change and no methylene blue was noted intraabdominally. After this negative test, most of the 400?mL of methylene blue flowed back into the urinary bag and the remaining blue-colored urine came in intermittent streams. A rectal digital examination did not reveal any injuries. Cystoscopy confirmed a distended bladder and two patent ureteral meatus. No trace of methylene blue was identified within the bladder. At the end of the cystoscopy procedure, a fold was noted on the posterior wall of the bladder neck (see Figure 1). This fold was initially thought to be iatrogenic. Insertion of the cystoscope inside this fold revealed a dilated peristaltic tubular structure containing methylene blue. This finding confirmed that the urinary catheter entered this ectopic ureter, and not the bladder. In order to avoid this fold and empty the bladder, a urinary catheter was placed under direct visualization. The postoperative course was uneventful and antibiotic prophylaxis was administered for 48 hours. Figure
Nursing actions to prevent urinary tract infection associated with long-standing bladder catheter
Fabrícia Alves Vieira
Einstein (S?o Paulo) , 2009,
Abstract: During hospital stay at the Intensive Care Unit (ICU), many treatments and procedures can breakdown the body defense mechanisms leading to infections. Urinary tract infections are the most frequent. This study was carried out in order to emphasize the standardization of nurse care, with the aim of reducing the ICU patient risk of developing urinary tract infections associated with indwelling bladder catheters.
A Novel Intraurethral Device Diagnostic Index to Classify Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms  [PDF]
Leonardo O. Reis,Guilherme C. Barreiro,Alessandro Prudente,Cleide M. Silva,José W. M. Bassani,Carlos A. L. D'Ancona
Advances in Urology , 2009, DOI: 10.1155/2009/406012
Abstract: Objectives. Using a urethral device at the fossa navicularis, bladder pressure during voiding can be estimated by a minimal invasive technique. This study purposes a new diagnostic index for patients with lower urinary tract symptoms (LUTSs). Methods. Fifty one patients presenting with LUTSs were submitted to a conventional urodynamic and a minimal invasive study. The results obtained through the urethral device and invasive classic urodynamics were compared. The existing bladder outlet obstruction index (BOOI) equation that classifies men with LUTSs was modified to allow minimal invasive measurement of isovolumetric bladder pressure in place of detrusor pressure at maximum urine flow. Accuracy of the new equation for classifying obstruction was then tested in this group of men. Results. The modified equation identified men with obstruction with a positive predictive value of 68% and a negative predictive value of 70%, with an overall accuracy of 70%. Conclusions. The proposed equation can accurately classify over 70% of men without resorting to invasive pressure flow studies. We must now evaluate the usefulness of this classification for the surgical treatment of men with LUTSs. 1. Introduction Invasive pressure flow studies (PFSs) in urodynamics are still the gold standard method for objective classification of bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTSs). It is able to delineate patients for successful surgical approach [1], however, it is still costly, time-consuming, and associated with significant morbidity. The risks of complications after conventional urodynamic study in men with BOO are greater, and acute urinary retention, macroscopic hematuria, urinary tract infection, and/or fever can occur in over 19% of the cases [2]. During the past 14 years, many experts have raised minimal invasive possibilities as substitutes [3, 4]. Griffiths et al. have previously described and validated a minimal invasive technique based on controlled inflation of a penile cuff during voiding [5]. Others had attempted other types of penile cuffs and condoms with insufficient results [3, 6–9]. Trying to overcome these limitations, we developed, in association with the University’s Biomedical Engineering Department, a urethral device capable of extracting from the voiding patient measurements comparable to those achieved from invasive PFS [10]. We have published before that applying logistic regression fitting to the minimal invasive method utilizing this urethral device was able to detect most patients with BOO [10]. However, the
Neurogenic Bladder and Multiple Sclerosis  [PDF]
V.N. Krupin,А.N. Belova
Sovremennye Tehnologii v Medicine , 2011,
Abstract: There have been presented general information of neurogenic bladder and the data on pathophysiology of lower urinary tract dysfunction in patients with multiple sclerosis. The characteristics of clinical presentations of neurogenic bladder in multiple sclerosis have been stated. There have been considered diagnosis and treatment problems of urinary disorders in patients with multiple sclerosis.
Exercise-Induced Hematuria as the Main Manifestation of Migration of Intrauterine Contraceptive Device into the Bladder  [PDF]
Michel Platiny Mascarenhas,Ricardo Brianezi Tiraboschi,Victor Pereira Paschoalin,Ellen Almeida Possidonio Costa,Carlos Henrique Suzuki Bellucci,José Bessa Junior
Case Reports in Urology , 2012, DOI: 10.1155/2012/736426
Abstract: Intrauterine device (IUD) is a common contraceptive method, due to its cost-effectiveness and low complication rates. Uterine perforation is a possible complication and IUD migration to the bladder is a rare and morbid condition. The present report describes an interesting case in which the urinary manifestations started 13 years after insertion, and the main clinical finding was exercise-induced hematuria. 1. Introduction Intrauterine device (IUD) is a widely used reversible contraceptive method, due to its cost-effectiveness and low complication rates [1]. Serious complications are rare; however migration to adjacent pelvic organs is described [2], including the bladder with stone formation and lower urinary tract symptoms [3]. We describe a case of intravesical IUD migration with urologic manifestations started 13 years after insertion, and the main clinical finding was exercise-induced hematuria. 2. Case Report A previously healthy 39-year-old woman presented with recurrent episodes of gross hematuria after middle distance running (5 to 10?km) that ceased some hours after sports activity, rest, and hydration. Moreover, she reported dysuria, urge to urinate, and suprapubic pain, which also worsened with physical activity. Those symptoms were present for the past 4 months and worsened progressively, becoming more intense in recent weeks. In her previous medical and gynecologic anamnesis, she informed that 13 years ago she underwent implantation of IUD, few weeks after cesarean delivery. After the IUD implant, she complained of suprapubic pain and vaginal bleeding treated with rest and analgesics, with remission of symptoms after approximately 1 month. She was assessed by vaginal ultrasound and informed that IUD was not visualized; twelve years after the implantation of IUD she became pregnant again and had a second cesarean. Gynecologic examination was normal, urinalysis revealed microhematuria, and leukocyturia and urine culture demonstrated the presence of Escherichia coli. She was treated with antibiotics, with remission of symptoms only for 4 weeks. Due to recurrence of the symptoms, she was referred to the urologic department for further evaluation. Ultrasonography demonstrated a 20?mm calculus in the bladder dome (Figure 1) and pelvic helical computed tomography revealed a metallic foreign body partially located intravesically with adjacent calcification (Figure 2). Cystoscopy, performed under anesthesia, confirmed the intravesical IUD (partial), complicated by stone that was grasped by forceps, and extracted completely through the endoscopy
Cesarean Section without Urethral Catheterization: A Randomized Control Trial  [PDF]
S Acharya,DK Uprety,HP Pokharel,R Amatya,R Rai
Kathmandu University Medical Journal , 2012, DOI: 10.3126/kumj.v10i2.7337
Abstract: Background Urethral catheterization is done as a routine procedure in cesarean section. It is associated with high incidence of urinary tract infections, discomfort, delayed ambulation and longer hospital stay.
Neurogenic Bladder  [PDF]
Peter T. Dorsher,Peter M. McIntosh
Advances in Urology , 2012, DOI: 10.1155/2012/816274
Abstract: Congenital anomalies such as meningomyelocele and diseases/damage of the central, peripheral, or autonomic nervous systems may produce neurogenic bladder dysfunction, which untreated can result in progressive renal damage, adverse physical effects including decubiti and urinary tract infections, and psychological and social sequelae related to urinary incontinence. A comprehensive bladder-retraining program that incorporates appropriate education, training, medication, and surgical interventions can mitigate the adverse consequences of neurogenic bladder dysfunction and improve both quantity and quality of life. The goals of bladder retraining for neurogenic bladder dysfunction are prevention of urinary incontinence, urinary tract infections, detrusor overdistension, and progressive upper urinary tract damage due to chronic, excessive detrusor pressures. Understanding the physiology and pathophysiology of micturition is essential to select appropriate pharmacologic and surgical interventions to achieve these goals. Future perspectives on potential pharmacological, surgical, and regenerative medicine options for treating neurogenic bladder dysfunction are also presented. 1. Background Normal micturition involves proper function of both the bladder and urethra. A detrusor of normal compliance and a physiologically competent urethral sphincter are both necessary to maintain urinary continence. Any increase in abdominal pressure, which inherently produces an increase in bladder pressure, is normally counteracted by an even greater increase in urethral pressure. Normal micturition involves passive, low pressure filling of the bladder during the urine storage phase while voiding requires coordination of detrusor contraction with internal and external urinary sphincter relaxation. This micturition process is controlled by the central nervous system, which coordinates the sympathetic and parasympathetic nervous system activation with the somatic nervous system to ensure normal micturition with urinary continence [1]. Voiding dysfunction can result from any mechanical or physiologic defects in the micturition system that result in the inability of the urinary sphincter to appropriately increase (or decrease) its pressure in response to increased bladder pressure. Damage or diseases of the central, peripheral, and autonomic nervous systems may result in neurogenic bladder dysfunction. Neurogenic bladder dysfunction may complicate a variety of neurologic conditions. In the United States, neurogenic bladder affects 40–90% of persons with multiple sclerosis, 37–72%
Bladder Calculus Following an Unusual Vesical Foreign Body
A Bello, GD Kalayi, HY Maitama, NH Mbibu, DU Kalba
Journal of Surgical Technique and Case Report , 2009,
Abstract: Bladder calculus following vesical foreign bodies is uncommon. The usual presentation is presence of lower urinary symptoms. Most of these foreign bodies are either left inadvertently after open bladder operations or migrate from adjacent structures. This is a case report of an unusual self inserted foreign body in a female presenting with bladder calculus and diverticulum. Self inserted foreign body, particularly in females, is one of the important causes of bladder stones. Foreign body in the bladder should be suspected in a female patient with chronic lower urinary tract symptoms even in the absence of trauma or intervention Key Words: Urinary Bladder, Calculus, Foreign body
Primary amyloidosis of urinary bladder
Basri ?ak?ro?lu,Lora Ate?,Ramazan G?zükü?ük,Mustafa Gü?lü
Dicle Medical Journal , 2013,
Abstract: Primary amyloidosis of the bladder is a rare pathologicalcondition, which the etiology is unknown. The signsand symptoms suggests bladder tumor. In some patients,lower urinary tract symptoms such as lower abdominalpain, frequent urination, dysuria and complaints of grosspainless hematuria occur. In this study, a case of primarylocalized amyloidosis of the bladder in a 66 years oldfemale who had gross painless hematuria as the initialsymptom is described.Key words: Amyloidosis, bladder, hematuria
Bladder Diverticulitis: A Case Report
Michael Silberman,Rebecca Jeanmonod
Case Reports in Emergency Medicine , 2011, DOI: 10.1155/2011/303498
Abstract: Bladder diverticulum, an outpouching of the mucosa through the muscular wall of the bladder, is a multifactorial disease process that can be either acquired or congenital. Although small diverticuli are usually asymptomatic, a large diverticulum may result in hematuria, urinary tract infection, acute abdomen due to its rupture, acute urinary retention, or neoplasm formation. We describe the case of an elderly gentleman who presented to the emergency department with abdominal pain and was ultimately diagnosed with bladder diverticulitis, a disease not previously described in the literature.
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