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Primary Malignant Melanoma of the Bladder: A Rare Case Report
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Background
Primary malignant melanoma (PMM) of the bladder is a rare ailment and has a poor prognosis; only 40 cases of PMM reported in literature till date. In this case report we described a case of PMM of the bladder, treatment, and a review of the literature as the recommended treatment choices are not widely known.
Case Presentation
A 55-year-old Indian female came with a history of hematuria for two-months. Ultrasonography revealed a 18×16 mm size mass located in the antero-inferior wall of urinary bladder with involvement of bladder neck. She underwent transurethral resection of the bladder tumor outside and histologically reported to be malignant melanoma and confirmed on immunohistochemistry (IHC). No further primary sites of melanoma were found. Computed tomography (CT) showed an irregular enhancing mucosal thickening along internal urethral meatus and adjacent urinary bladder. The patient eventually underwent radical cystectomy with anterior pelvic exenteration with ileal conduit.
Conclusion
Primary bladder melanoma is very aggressive in nature. In most of the cases bladder malignant melanoma is secondary, so extensive search for any primary melanotic lesion is essential. It is often difficult to discriminate whether a bladder melanoma is primary or metastatic. Certain diagnostic features can be obtained through histopathological investigation, immuno-histochemistry, clinical history, and endoscopic evaluation. Despite a wide range of treatments, people with PMM still have a worst prognosis.
Keywords
Primary malignant melanoma (PMM); Hematuria; Anterior pelvic exenteration; Immunohistochemistry.
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Single Dose Diclofenac and Tamsulosin Effectiveness in Patients Undergoing Double J-Stent Removal Under Local Anaesthesia
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Purpose
The purpose of this study was to see effectiveness of diclofenac sodium and tamsulosin combination on patients’ pain perception after ureteral stent removal.
Materials and Methods
Study was carried out from October 2019 to March 2021. All patients with unilateral stent placement after renal or ureteric stone endoscopic surgery were randomized in 3 groups. Group-A include 20 patients who were given placebo drug 2-hours prior to double J (DJ) removal. Group-B included 20 patients who were given oral diclofenac 2-hours prior to DJ removal. Group-C included 20 patients who were given oral diclofenac and tamsulosin 2-hours prior to DJ removal. All patients received 10 cc 2% viscous lidocaine intraurethral before cystoscopy. No sedatives or analgesics were administered during the procedure. All patients provided consent before the procedure and they were asked to record their pain experience on a visual analog pain scale as soon as the procedure was finished. The pulse rate and systolic and diastolic blood pressure (BP) were also recorded 5-minutes before the procedure and during the procedure
Results
General characteristic of age, gender and indication for DJ-stenting were comparable in all groups. The mean pain score on the visual analogue scale (VAS) in Group-C was significantly lower than that in Group-A and B (p<0.001) A statistically significant difference was found between the two groups in terms of anxiety scores after cystoscopy, intraoperative systolic BP and pulse rate. Patients who were given oral diclofenac and tamsulosin two hours prior to DJ removal experienced less pain and anxiety. Conclusion Oral diclofenac plus tamsulosin combination prior to DJ removal improves patient’s comfort. Keywords Diclofenac; Tamsulosin; DJ removal.
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Spontaneous Bladder Rupture: A Rare Case of an Acute Abdomen
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Spontaneous idiopathic rupture of the bladder (SIBR) is still a rare occurrence. Although a few cases of bladder wall rupture associated with bladder wall disease have been documented in the literature, there are limited cases reported worldwide. We describe a patient who presented to the Emergency Department of Tauranga Hospital in New Zealand with diffuse abdominal pain due to a bladder rupture confirmed by a CT-scan. Despite no obvious explanation a relationship with an alcohol binge was posited. He underwent surgery and recovered completely.
Keywords
Spontaneous; Bladder; Rupture; Atraumatic; Urine extravasation.
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Current Issue
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Paediatric Urolithiasis an Emerging Concern: Single Centre Experience in a Non-Endemic Region in South India
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Introduction
Paediatric urolithiasis is an emerging disease in developing nations especially in India, but a rarer entity compared to its adult counterpart. There is significant geographic variation in the incidence of urolithiasis within India itself. Given the changing dynamics of the disease, this study evaluated paediatric urolithiasis patients in a non-endemic region in South India.
Methods
This is a retrospective study of children and adolescents diagnosed with urolithiasis from January 2009 to December 2019 in a single tertiary care centre in South India. The purpose of this study was to investigate and identify the demographic and clinical characteristics, aetiology, management, clearance rates after surgical intervention and disease recurrence of paediatric stone disease
in a non-endemic region in South India.
Results
We evaluated 29 patients which included a total of 97 hospital admissions. Predominantly the study population consisted of males (80.0%), with a mean age of symptom onset of 9.44±5.53-years. All patients were metabolically evaluated, 16 patients (55.2%) had metabolic abnormalities and the most common abnormality was hypocitraturia (37.5%). Spontaneous elimination rate was 6.9% and clearance rates for surgical procedures ranged from 72% to 100%. Recurrent stones were seen in 37.9%. No patient developed chronic kidney disease or mortality due to stone disease within the evaluation period of this study.
Conclusion
Paediatric urolithiasis is an emerging disease in India. There is a high prevalence of metabolic abnormalities in paediatric stone disease which supports the need for metabolic evaluation in all cases. There is more similarity of our study with western literature than the available Indian data which may be due to the lifestyle changes, significant geographic variation within India itself between
endemic and non-endemic regions or changing epidemiology of paediatric stone disease per se.
Keywords
Paediatrics; Urolithiasis; Urinary tract infection (UTI).
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Pulsed Electromagnetic Stimulation Therapy for Erectile Dysfunction
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Erectile dysfunction (ED) is a significant and common medical problem. Currently, there are several treatment available options for patients with ED, both non-invasive and invasive like phosphodiesterase 5 inhibitors, intra-cavernosal injections (BIMIX,TRIMIX), intraurethral prostaglandin E1 pellets, vacuum erection devices and insertion of a penile prosthesis. Most of these options are
invasive, which can be troublesome for patients, and also have side-effect profiles. Pulsed-electro magnetic stimulation therapy (PLMST) has gained interest in the field of sexual medicine. In the given case author presented a successful effect of in a case of erectile dysfunction.
Keywords
Erectile dysfunction; Electromagnetic stimulation therapy; Latest treatment; Non-invasive treatment;
Erection hardness scale (EGS).
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Botulinum Toxin Type A in Neurogenic Overactive Bladder Dysfunction in Patients with Multiple SclerosisBotulinum Toxin Type A in Neurogenic Overactive Bladder Dysfunction in Patients with Multiple Sclerosis
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Introduction
Lower Urinary tract symptoms are common in patients with multiple sclerosis (MS) and have a negative influence on the quality of life (QoL). Detrusor overactivity is the most frequent symptom. Lifestyle modifications are the first therapeutic line followed by oral medication in patients with storage dysfunction. When these drugs are ineffective or intolerable, botulinum toxin bladder injection is an alternative treatment. The aim of this work is to evaluate the effectiveness and the impact on QoL of patients with MS and refractory or intolerant to oral therapy overactive bladder (OAB) after botulinum toxin type A bladder injection.
Materials and Methods
Retrospective study with six-months follow-up of patients with MS diagnosis and a refractory or intolerable to oral drugs OAB treated with botulinum toxin injections. All patients completed urological evaluation and a QoL questionnaire prior to the injection, 3 and 6-months after. Evaluation of the urodynamics tests prior and 3-months post injection was made.
Outcomes
Sixteen patients were treated. The QoL questionnaire showed progressive improvement 3 and 6-months after the injection. There was decrease in the number of daily voids urination and in the urinary incontinence episodes. There was an upgrade in the bladder capacity from 191 to 338 ml average (p 0.0004) and 75% evidenced disappearance of detrusor overactivity (p 0.0005). Thirteen (13) patients (81.25%) made spontaneous urination with post-voiding residue <100 ml after injection. Three (3) episodes of urinary tract infection were evidenced. Conclusion Botulinum toxin generates a positive impact on the QoL of patients with neurogenic OAB with MS.
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Scrotal Microcystic Lymphangioma: A Case Report with Clinical and Dermoscopic Aspects
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Pleomorphic Giant Cell Carcinoma of Urinary Bladder with Brain Metastases Despite Initial Response to Cisplatin and Gemcitabine: A Case Report
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Tumour Volume of the Index Lesion in Prostate Cancer: Correlation between Results of Multiparametric Magnetic Resonance Imaging and the Histophatology
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Malpositioned Right Ureteral Stent into the Duodenum: A Rare Case Report
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Previous Issue
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Testicular Metastasis of Merkel’s Cell Carcinoma
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Merkel cell carcinoma (MCC) in an uncommon neuroendocrine neoplasia that originates in the skin in which testicular metastasis is atypical. There are only eight cases reported to date. A 65-year-old patient with a history of MCC in the right thigh who had been treated in 2015 with surgery, chemotherapy and radiation therapy; presented to hospital with pain and right testicular enlargement of one-month duration and with normal testicular tumor markers. An ultrasound study confirmed multiple hypoechoic nodular solid lesions compatible with neoplasia and orchiectomy was subsequently performed. The histological examination reported an immunohistochemical pattern compatible with a diagnosis of MCC. The patient received adjuvant immunotherapy with Avelumab. MCC rarely spreads to the testicle and, due to the shortage of studies, the best treatment of testicular metastasis remains uncertain; however, immunotherapy may be appropriate.
Keywords
Merkel; Testicular metastasis.
Scrotal Microcystic Lymphangioma: A Case Report with Clinical and Dermoscopic Aspects
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Cystic lymphangioma is a relatively frequent condition. However, the scrotum is one of the least common sites. The diagnosis is made with ultrasonography and the treatment of limited and circumscribed cases, is surgical excision or sclerotherapy where appropriate. We report the case of a 23-year-old boy who presented with asymptomatic scrotal vesicular lesions evolving over 6-years. Clinical and dermoscopic examination supported by ultrasound and histology were in favor of a microcystic lymphangioma.
Keywords
Cystic Lymphangioma; Circumscriptum; Scrotum; Clinic; Dermoscopy.
Pleomorphic Giant Cell Carcinoma of Urinary Bladder with Brain Metastases Despite Initial Response to Cisplatin and Gemcitabine: A Case Report
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A 59-year-old male presented with haematuria and was diagnosed with pleomorphic giant cell carcinoma of the urinary bladder, a very rare variant of urothelial carcinoma. The tumour was staged at pT2N3M1 and the primary tumour was removed by transurethral resection, and nodal metastases were treated with the standard systemic cisplatin and gemcitabine for urothelial cell carcinoma of the bladder. This treatment rendered the tumour clinically undetectable. Despite this treatment the patient developed brain metastases which were not found until the patient presented with neurological symptoms. This is the first recorded case of brain metastases from pleomorphic giant cell carcinoma of the urinary bladder recorded in the literature. CT imaging of the brain should be considered in the follow-up in patients with this tumour.
Keywords
Urinary bladder; Brain metastases despite; Cisplatin and gemcitabine.
Tumour Volume of the Index Lesion in Prostate Cancer: Correlation between Results of Multiparametric Magnetic Resonance Imaging and the Histophatology
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Introduction
Prostate cancer is generally multifocal, presenting a lesion with a dominant focus (index lesion) that is characterized by being the lesion with the greatest volume and the biological capacity of invasion to adjacent tissues and distant metastases. With the advent of focal therapy and organ preservation in prostate cancer, it is essential to know the real tumour volume and thus, avoid the persistence of disease after treatments with curative intent. The aim of this study is to correlate the results of the dominant tumour volume obtained from the multiparametric magnetic resonance imaging (MRI) of the prostate and the histopathology.
Material and Methods
A retrospective study was performed which included all radical prostatectomies (RP) with previous MRI. A comparative analysis was performed between the tumour volume obtained from the MRI and the histopathology.
Results
A total of 46 patients were included in the study. The sensibility of the MRI in diagnosing the index lesion was 82.6%, highlighting that all tumours with a Gleason score ≥ 4+3 were diagnosed. The mean tumour volume in the MRI was 14.3 mm and in the histological result was 18.82 mm (p<0.05). The estimation tumour volume concordance was greatest in higher risk (International Society of Urological Pathology (ISUP)).
Conclusion
The MRI underestimates the real tumour volume of the prostate cancer index lesion when compared to the histological result of the surgical piece, being significantly lower in high-risk lesions.
Keywords
Prostate cancer; MRI; Radical prostatectomy; Index lesion; Tumour volume.
Malpositioned Right Ureteral Stent into the Duodenum: A Rare Case Report
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Double J (DJ) stenting is a routine procedure in our urological practice to treat ureteral obstruction. We report a rare case where the proximal coil of a DJ stent was found in the second part of duodenum diagnosed on imaging and confirmed by upper gastrointestinal endoscopy, in a patient with chronic right flank pain who underwent emergency right DJ stenting elsewhere. He presented to our institution 3-months later for further management. It is important to be aware of all possible complications before placing DJ stents and be aware that if any such complication arise, they need to be dealt with early. It is important to avoid blind DJ stent insertion especially in acute or inflammatory conditions. One can avoid such situations by stenting under image guidance and preferably with a retrograde pyelogram (RGP) or by deploying a guidewire under direct vision using a ureteroscope. If stent malposition is suspected then early detection and replacement of the malpositioned DJ stent under fluoroscopic guidance is an essential step in management.
Keywords
Double J stenting; DJ stent malposition; Upper GI endoscopy; DJ stent coil in duodenum; Right contracted kidney; Inflammatory
retroperitoneal mass; Laparoscopic nephrectomy.
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