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Background: Current practices in nephrostomy exchange are guided by institutional or societal expert-consensus rather than evidence-based recommendations. Objective: To examine the temporal distribution of exchanges and assess whether the observed distributions align with institutional, or expert-recommended guidelines where routine exchanges would be expected to occur within 60–89 days. Non-routine exchanges would be expected to occur either after 60 days or after 89 days. Methods: Data were collected from the Merative™ MarketScan Commercial Claims and Encounters Databases and included all patients who underwent a PCN exchange from 2009 to 2021. The dataset was queried using ICD-9/10 and CPT coding systems. Outpatient exchanges were classified as routine exchanges, whereas inpatient exchanges were classified as non-routine exchanges. Chi-Square Goodness-of-Fit tests were used to compare observed frequencies against expected distributions of routine exchanges within the 59–89 day window, and non-routine exchanges to occur after either 60 or after 89 days. Results: There was a total of 19,689 exchanges: of those, 41% (n = 8,058) exchange encounters occurred within 29 days, 67% (n = 13,213) occurred within 59 days, and 81% (n = 15,899) occurred within 89 days. Routine exchanges accounted for 76% of total exchanges: of those routine exchanges, 39% (n = 5,863) of routine exchanges occurred within 29 days, 67% (n = 10,057) occurred within 59 days, and 82% (n = 12,256) occurred within 89 days. Non-routine exchanges account for 24% of all exchanges in the study cohort. Of all non-routine exchanges (n = 4,737), 46% (n = 2,035) of non-routine exchange encounters occurred within 29 days, 67% (n = 3,156) within 60 days, and 77% (n = 3,643) within 89 days. Chi-square tests indicated significant deviations from the expected distributions for both routine (p < 0.01) and non-routine (p < 0.01) exchanges. Conclusion: A significant proportion of routine exchanges occur outside a 60–89 day window, and with a majority of routine exchange observations occurring prior to 59 days. A significant proportion of non-routine exchanges occur prior to 60 days and prior to 89 days. Clinical impact: Significant disparities between existing guidelines and clinical practice, underscoring the need for evidence-based guidelines to reduce complication rates, improve patient outcomes, and reduce the burden of cost on the healthcare system. Highlights: Key findings A significant majority of routine percutaneous nephrostomy (PCN) exchanges occur outside the expert-recommend window, with many occurring earlier than 60–89 days. Additionally, a significant majority of non-routine exchanges occur earlier than either 60 or 90 days. Importance Discrepancies between observed and recommended clinical practice necessitate evidence-based guidelines for PCN management. [ABSTRACT FROM AUTHOR]

An inguinal bladder hernia (IBH) is an abnormal protrusion of the bladder into the inguinal canal accompanied by a peritoneum sheath that creates the hernia sac. Clinical presentations vary greatly from lower urinary tract symptoms (LUTS) and reduction in scrotal size after voiding to being entirely asymptomatic. Since inguinal bladder hernias are uncommon and often accompanied by varied and nonspecific symptoms, it is challenging to diagnose and rarely included in differentials. Currently, computerized tomography (CT) imaging with contrast or voiding cystourethrography is recommended for diagnosis. There is no consensus on the best treatment for inguinal bladder hernias, with options ranging from laparoscopic repair to catheterization. In this study, we report the case of inguinal bladder hernia in an 86-year-old male presenting with symptoms of recurrent hematuria and two failed voiding trials after a Foley catheter placement from prostatomegaly resulting in bladder diverticula, and IBH. He was treated with prostate artery embolization (PAE) to address LUTS related to benign prostatic hyperplasia (BPH). The resultant decreased prostatic volume resolved his symptoms of IBH, hematuria, and urinary retention.

Abstract Background Clients want to know the ultimate cause of death in their pet after cancer treatment. The cause of euthanasia and investigation of urinary obstruction in treated dogs with urothelial carcinoma (UC) has not been specifically reported in veterinary literature. Hypothesis/Objectives Our hypothesis was that the majority of treated dogs with UC are euthanized secondary to primary tumor factors, such as urinary obstruction. Animals Fifty‐nine client‐owned dogs diagnosed with UC. Methods Retrospective observational study on clinical signs and disease at euthanasia of dogs with UC treated by radiation therapy or chemotherapy or both. Results The median overall survival time (OST) of all dogs was 339 days (range, 17‐1996; 95% confidence interval [CI], 185‐392; interquartile range [IQR], 112‐505). Of dogs deemed to have been euthanized because of UC (50/59, 85%), the primary cause was considered to be local progression in 31/50 (62%), most often because of perceived complete or partial urinary obstruction (24/31, 77%). No variables were found to be predictive of urinary obstruction. The overall documented metastatic rate was 56%. In dogs euthanized because of UC, metastasis was deemed to be the cause in 19/50 (38%) dogs. Conclusions and Clinical Importance Regardless of the type of treatment, UC in dogs has a poor prognosis and there is a continuing need to improve treatments that focus on local control of the primary tumor, given its high contribution to the decision for euthanasia. Proactive management to avoid the high frequency of urinary obstruction may be worthy of future investigation.

This report describes a case of transmural migration of a gossypiboma from the peritoneum into the urinary bladder in a 4-year-old, female spayed, mixedbreed dog. The dog was presented on an emergency basis for complete urethral obstruction with radiographic evidence of urocystolithiasis. An exploratory laparotomy was performed and a 4-5 cm mass was identified which was confluent with the apex of the urinary bladder. The mass and bladder were exteriorized and isolated, and an apical, partial cystectomy was performed to remove the mass and gain access to the uroliths within the lumen of the bladder. A 4x4 surgical sponge was identified within the trigone of the bladder, it had multiple uroliths; another sponge was also found within the mass itself. This case demonstrates an atypical cause of urethral obstruction and serves as the first reported case of transmural migration of a gossypiboma into the urinary bladder of a dog. It also illustrates the importance of establishing routine operating procedures including gauze counts and the use of radiopaquelabeled surgical gauze. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of red blood cell (RBC) transfusions and factors associated with the need for transfusion in cases of feline urethral obstruction (FUO). Secondarily, to compare survival to discharge in cats receiving an RBC transfusion versus those that did not. Design: Retrospective, multi‐institutional study from 2009 to 2019. Setting: Four university teaching hospitals. Animals: Six hundred twenty‐two total occurrences of FUO in 575 cats. Interventions: None. Measurements and Main Results: Medical records were retrospectively reviewed for pertinent information. The overall prevalence of severe anemia (PCV < 0.20 L/L [<20%]) at presentation was 1.0% (6/622). The prevalence of RBC transfusions during hospitalization was 2.1% (13/622). Cats that received an RBC transfusion weighed significantly less than those that did not (4.9 vs 5.8 kg; P = 0.034) and had a lower PCV at presentation (0.30 L/L [30%] vs 0.41 L/L [41%]; P < 0.001). Hospitalization time (240 vs 72 h) and indwelling urinary catheter time (168 vs 48 h) were significantly longer in cats receiving a transfusion compared with those that did not (P < 0.001). Creatinine concentrations were not significantly associated with transfusion administration, while BUN was higher in cats receiving a transfusion (15.35 mmol/L [43 mg/dL] vs. 11.78 mmol/L [33 mg/dL]; P = 0.043). Transfusion rates were significantly higher in cats undergoing perineal urethrostomy (5.5%) compared with those that did not undergo surgery (0.97%; P < 0.001). The overall survival to discharge rate was 96%. Cats not receiving an RBC transfusion were significantly more likely to survive to discharge than those that did (odds ratio: 14.7, 95% confidence interval: 1.8–37; P < 0.001). Conclusions: FUO is rarely associated with severe anemia and the need for RBC transfusions. In this study, cats receiving an RBC transfusion were less likely to survive to discharge; therefore, requiring a blood transfusion may be associated with a worse prognosis. In addition, the need for surgical intervention was associated with a higher prevalence of RBC transfusions. [ABSTRACT FROM AUTHOR]

Background/aim: Urethroplasty is the preferred treatment for hypospadias but is affected by the severity of anomalies, making it a complex procedure with potential postoperative complications. Following surgery, parents receive instructions and recommendations, whether from nurses or physicians, regardless of complication rates. However, nurses play a crucial role in educating caregivers before surgery and providing postoperative care during follow-up. The study aims to assess parents' knowledge and practices, as well as the frequency of complications in boys who underwent urethroplasty for hypospadias and received postoperative nurse-led care and whose parents received preoperative education against those of boys who underwent urethroplasty under routine hospital care. Materials and methods: In this retrospective study, Han Chinese boys aged 21--41 months in Western China who underwent urethroplasty for hypospadias were divided into two groups: the NI cohort (n = 103), where they received postoperative nurse-led care and their parents received preoperative education, and the RH cohort (n = 142), where boys underwent routine hospital care. Results: After urethroplasty, higher numbers of caregivers with satisfactory knowledge (96 (93%) vs. 80 (56%), p < 0.0001) and practice (102 (99%) vs. 132 (93%), p = 0.0276) were reported in the NI cohort compared to the RH cohort. Additionally, a higher number of boys in the RH cohort experienced adverse effects such as moderate bleeding (13 (9%) vs. 1 (1%), p = 0.0052), wound infection (17 (12%) vs. 4 (4%), p = 0.0356), urinary obstruction (35 (25%) vs. 10 (10%), p = 0.0049), burning sensation (47 (33%) vs. 15 (15%), p = 0.0019), and urinary stent fall (32 (23%) vs. 6 (6%), p = 0.0008) compared to those in the NI cohort. Conclusion: Preoperative instructions enhance caregivers' knowledge and practices following urethroplasty, while postoperative nurseled care reduces immediate postoperative complications associated with hypospadias in boys. [ABSTRACT FROM AUTHOR]

Background: Clients want to know the ultimate cause of death in their pet after cancer treatment. The cause of euthanasia and investigation of urinary obstruction in treated dogs with urothelial carcinoma (UC) has not been specifically reported in veterinary literature. Hypothesis/Objectives: Our hypothesis was that the majority of treated dogs with UC are euthanized secondary to primary tumor factors, such as urinary obstruction. Animals: Fifty‐nine client‐owned dogs diagnosed with UC. Methods: Retrospective observational study on clinical signs and disease at euthanasia of dogs with UC treated by radiation therapy or chemotherapy or both. Results: The median overall survival time (OST) of all dogs was 339 days (range, 17‐1996; 95% confidence interval [CI], 185‐392; interquartile range [IQR], 112‐505). Of dogs deemed to have been euthanized because of UC (50/59, 85%), the primary cause was considered to be local progression in 31/50 (62%), most often because of perceived complete or partial urinary obstruction (24/31, 77%). No variables were found to be predictive of urinary obstruction. The overall documented metastatic rate was 56%. In dogs euthanized because of UC, metastasis was deemed to be the cause in 19/50 (38%) dogs. Conclusions and Clinical Importance: Regardless of the type of treatment, UC in dogs has a poor prognosis and there is a continuing need to improve treatments that focus on local control of the primary tumor, given its high contribution to the decision for euthanasia. Proactive management to avoid the high frequency of urinary obstruction may be worthy of future investigation. [ABSTRACT FROM AUTHOR]

Endometriosis presents a diagnostic conundrum due to its diverse clinical manifestations, ranging from asymptomatic to acute obstructive uropathy. This is a case of a 30-year-old woman with a history of endometriosis and rapidly progressing left flank pain culminating in rupture of the renal pelvis in her left kidney. Initial investigations revealed left-sided hydronephrosis without evidence of nephrolithiasis. Subsequent imaging showed active extravasation indicative of urinary obstruction attributable to endometriosis. Placement of a left nephrostomy tube alleviated her symptoms, and follow-up imaging revealed a distal ureteral stricture. A stent was subsequently placed, which resolved the obstruction and obviated the need for extensive surgical intervention. In this case, the patient's history of endometriosis prompted consideration of its role in urinary obstruction, despite the absence of typical symptoms, and underscores the importance of considering endometriosis as a potential cause of acute urinary obstruction, particularly in patients with a history of the disease. Physicians in the emergency department should maintain a high index of suspicion for endometriosis-related complications to facilitate timely intervention and prevent adverse outcomes. Awareness of the variable presentations of endometriosis is paramount for ensuring comprehensive patient care and optimal outcomes.

Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of infected urolithiasis, including presentation, diagnosis, and management in the emergency department based on current evidence. Although urolithiasis is common and the vast majority can be treated conservatively, the presence of a concomitant urinary tract infection significantly increases the risk of morbidity, to include sepsis and mortality. Identification of infected urolithiasis can be challenging as patients may have symptoms similar to uncomplicated urolithiasis and/or pyelonephritis. However, clinicians should consider infected urolithiasis in toxic-appearing patients with fever, chills, dysuria, and costovertebral angle tenderness, especially in those with a history of recurrent urinary tract infections. Positive urine leukocyte esterase, nitrites, and pyuria in conjunction with an elevated white blood cell count may be helpful to identify infected urolithiasis. Patients should be resuscitated with fluids and broad-spectrum antibiotics. Additionally, computed tomography and early urology consultation are recommended to facilitate definitive care. An understanding of infected urolithiasis can assist emergency clinicians in diagnosing and managing this potentially deadly disease. [ABSTRACT FROM AUTHOR]

This report describes a case of transmural migration of a gossypiboma from the peritoneum into the urinary bladder in a 4-year-old, female spayed, mixed-breed dog. The dog was presented on an emergency basis for complete urethral obstruction with radiographic evidence of urocystolithiasis. An exploratory laparotomy was performed and a 4–5 cm mass was identified which was confluent with the apex of the urinary bladder. The mass and bladder were exteriorized and isolated, and an apical, partial cystectomy was performed to remove the mass and gain access to the uroliths within the lumen of the bladder. A 4×4 surgical sponge was identified within the trigone of the bladder, it had multiple uroliths; another sponge was also found within the mass itself. This case demonstrates an atypical cause of urethral obstruction and serves as the first reported case of transmural migration of a gossypiboma into the urinary bladder of a dog. It also illustrates the importance of establishing routine operating procedures including gauze counts and the use of radiopaque-labeled surgical gauze.

Objective: This study highlights a case of uroperitoneum from urinary bladder rupture in a bovine calf and further describes the surgical interventions. Materials and Methods: A 7-month-old weaned Brahma bull-calf was presented with a distended abdomen alongside a history of complete absence of urination for 9 days. Previously, the animal suffered from urinary inconsistence and dribbling-type urination. Physical palpation on the ventral aspect of the distended abdomen revealed a fluid-filled condition, and further needle aspiration confirmed the fluid to have a slightly alkaline pH resembling that of urine. The preputial manipulation and urinary catheterization were of no use for the obstruction. A light uremic smell was found in the animal's breathing. Elevated blood urea nitrogen and creatinine were also detected. Clinically, it was assumed to be a ruptured urinary bladder (cystorrhexis) and subsequently diagnosed as a case of uroperitoneum (water belly). Paramedian laparotomic exploration was carried out to detect the ruptured part (perforation) of the bladder, and simultaneous expulsion of the accumulated peritoneal urine was done. A tube cystostomy was performed with Foley's catheter to handle the case after repairing the perforated bladder (cystorrhaphy). In the postoperative phase, supportive medications and good management were ensured. Results: The calf recovered within 2 weeks of surgery and was found to maintain unremitting urine flow through the surgically fixed catheter. However, the calf was culled after 1 month of surgery. Conclusions: Tube cystostomy can be an effective approach for the management of water bellies in calves to save lives. [Vet. Res. Notes 2023; 3(7.000): 58-62]

Objective: This case report will present transurethral resection of double anterior urethral valves in tertiary hospital. Case(s) Presentation: A three-year-old boy who complained of a poor stream of urine and discomfort during micturition. From the radiological examination, the main finding was found on ultrasound (USG), with thickening of the bladder wall without upper tract abnormality. On panendoscopy, we found double anterior urethral valves at bulbar part and trabeculation in bladder. Discussion: The resection of the valves was performed and achieved an excellent result included normal stream of urine and there was no discomfort during micturition. Conclusion: Anterior Urethral Valve is a rare case that can be caused a lower urinary tract obstruction. A good understanding of AUV’s radiological and endoscopic anatomy is required to differentiate it from other diseases, essential to prevent further injury, and also to decide for appropriate management. Keywords: Anterior Urethral Valve, Congenital Anomaly, Urinary Obstruction

This retrospective study aimed to determine the impact of percutaneous nephrostomy (PCN) on the quality of life (QOL) and kidney function of women with advanced carcinoma of the cervix and obstructive uropathy in Kenyatta National Hospital by utilizing data from 2016 to 2019 and a follow-up patient interview in 2020. Sociodemographic data from patient records was reported as descriptive statistics. Serum urea, hemoglobin and creatinine levels before PCN and 72 hours, 1 month and 3 months after PCN were obtained. The changes were analysed using a paired t-test. Quality of life data before and after PCN tube insertion were collected using the structured Functional Assessment of Cancer Therapy and a cervix cancer-specific subscale (FACT-Cx) questionnaire, responses scored and an aggregate tallied. The QOL and kidney function data variables before and after PCN tube insertion were compared with statistical significance set at p < 0.05. Fifty eight study participants were enrolled, with an 80% power to detect a 5 fold change in kidney function. Percutaneous nephrostomy had an overall improvement in the quality of life (FACT-Cx total p = 0.041) with changes in aspects of physical well-being (p = 0.018) and additional concerns sexual function, self-esteem, appearance, urinary function, appetite and gastrointestinal function (p ≤ 0.001); but none in other aspects of the tool. Improvement was noted 72 hours after PCN tube insertion in 62% of patients' urea (p = 0.033) and 64% of creatinine (p ≤ 0.001) levels but not sustained after 1 month and did not revert to normal levels. Hemoglobin levels did not improve. Percutaneous nephrostomy was found to have a short-term added value in management of women with obstructed uropathy in advanced carcinoma of the cervix as two aspects of their QOL improved while serum urea and creatinine levels improved slightly with no functional recovery. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a multisystemic disease of unknown cause, commonly affecting young and middle-aged adults. It frequently presents with bilateral hilar adenopathy, pulmonary infiltration, and skin lesions; the liver, spleen, lymph nodes, heart, central nervous system, and bone may be affected. A 41-year-old male who began with renal colic, when carrying out the protocol, is diagnosed through CT scan bilateral renal and ureteral lithiasis, however, during the inspection, the lymphadenopathy was highlighted, for which a biopsy was performed in the inguinal node where sarcoidosis is diagnosed. The diagnosis of sarcoidosis, in most of the cases, is given by exclusion because the clinical manifestations are varied. They consist of obstructive or restrictive airway patterns, uveitis, and skin injuries. Urinary symptoms as the initial clinical presentation are rare or unusual. [ABSTRACT FROM AUTHOR]

Objective: To determine the factors associated with renal function recovery in individuals with kidney failure due to obstruction in the urinary tract. Method: The prospective, descriptive study was conducted July 2020 to August 2021 at the Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, and comprised adult patients of either gender who had renal failure secondary to obstructive urinary tract. Baseline data regarding patients’ variables, including age, gender, duration of symptoms (25 days or 25 days), haemoglobin (9.85g/dl or 9.85g/dl), serum creatinine and renal cortical thickness (16.5mm or 16.5 mm), was noted on a proforma. The variables were stratified to assess impact on renal recovery. Data was analysed using SPSS 23. Results: Of the 126 patients, 43(34.13%) were males and 83(65.87%) were females. The overall mean age was 44.13±14.18 years. Renal recovery occurred in 67(78.8%) patients having duration of symptoms 25 days, and in 13(31.7%) patients with duration of symptoms 25 days (p 0.001). Renal recovery occurred in 41(58.6%) patients having haemoglobin 9.85g/dL and in 39(69.6%) patients having haemoglobin 9.85g/dL (p=0.2). Renal recovery occurred in 26(37.7%) patients with parenchymal thickness 16.5mm and in 54(94.7%) patients with renal cortical thickness 16.5mm (p 0.001). Conclusion: Symptom duration 25 days, and renal parenchymal thickness 16.5mm were found to be predictive factors of good recovery in renal failure cases secondary to obstructive uropathy. Key Words: Urinary obstruction, Obstructive nephropathy, Percutaneous nephrostomy, Renal failure.

Introduction In adults, rhabdomyosarcoma of the prostate is extremely rare and has an unfavorable prognosis. These patients frequently experience urinary obstruction, and cysto‐prostatectomy is a mainstay treatment for localized disease. In contrast, treatment strategies for the primary site for metastatic disease remain controversial. To our knowledge, robot‐assisted surgery for the primary tumor has not been reported. Case presentation A 26‐year‐old man complained of dysuria. Magnetic resonance imaging showed enlarged prostate and computed tomography revealed a pulmonary metastasis. Transurethral resection of the prostate led to the diagnosis of rhabdomyosarcoma. After chemotherapy, robot‐assisted prostatectomy was performed to relieve obstructive urinary symptoms. Although disease progression in the metastatic site was observed after the surgery, urinary obstruction did not occur and quality of life was well maintained. Conclusion Robot‐assisted prostatectomy may be beneficial both for local disease control and palliation of voiding impairment among selected patients with systemic rhabdomyosarcoma of the prostate.

Objective: To describe the complications, surgical outcome, and prognosis associated with cystotomies in guinea pigs., Methods: A retrospective review of medical records of guinea pigs undergoing cystotomy for uroliths or urethroliths between 2010 and 2023., Results: 25 guinea pigs were included in the study. Uroliths were confirmed on radiographs in all 25 cases, with 9 patients (36%) having at least 1 stone within the urethra. The cystotomy procedure was associated with an intraoperative complication rate of 24% and a short-term complication rate of 76%. Discomfort was the only presenting clinical sign significantly associated with survival, with a risk of dying prior to discharge that was a sixth of the risk of dying if a patient presented without signs of discomfort (risk ratio = 0.177). For patients with a stone within the urethra, the probability of death prior to discharge was 6 times that of patients with a stone within the bladder (P = .010; risk ratio = 5.966)., Conclusions: Cystotomies were associated with a mortality rate of 40% prior to discharge and 56% within the first month postoperatively. Further studies are needed to determine what specifically may lead to the high mortality rate as well as whether alternative minimally invasive procedures may be helpful in improving outcomes., Clinical Relevance: This study is the first to document risk factors, complications, and outcomes of a cohort of guinea pigs specifically undergoing cystotomy for urolithiasis. Given the high risk for complications and mortality, caution and owner preparation must be considered when a cystotomy is recommended for guinea pig patients.

Copyright of Yeni Üroloji Dergisi is the property of Ali Ihsan Tasci and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sergey V Popov,1– 3 Igor N Orlov,1,4 Daria Yu Chernysheva,1 Sergey M Malevich1 1Urology Department, St. Luke’s Clinical Hospital, Saint-Petersburg, Russia; 2Urology Department, Military Medical Academy Named After S.M. Kirova, Saint-Petersburg, Russia; 3Hospital Surgery Department, Saint-Petersburg State University, Saint-Petersburg, Russia; 4Urology Department, North-Western State Medical University Named After I.I. Mechnikov, Saint-Petersburg, RussiaCorrespondence: Daria Yu ChernyshevaUrology Department, St. Luke’s Clinical Hospital, Chugunnaya Street 46, Saint-Petersburg, 194044, RussiaTel +7921 873 85 60Fax +7812 576 11 55Email Daria.chern@gmail.comAbstract: Cystic formations in the prostate are quite common, but the vast majority are benign. The cystic form of prostate adenocarcinoma can present unexpected symptoms, and management can be difficult because of the local advanced stage of the disease. A unique feature of this case is the surgical local cancer treatment. In this clinical case, we describe the literature surrounding this rare form of neoplasm. We present a clinical case of a rare form of prostate cancer in a 71-year-old male who was admitted to ER with acute urinary retention. A huge obstructing prostatic cyst was revealed. After successful trial-without-catheter, the patient underwent transperineal cyst draining and this restored urination. PSAt was increased up to 55 ng/mL. The cystic wall biopsy revealed adenocarcinoma with a Gleason score of 8 (4+4) (Gleason Group IV), and distant metastasis was noticed with PSMA PET/CT. The patient started androgen deprivation therapy (ADT) with excellent PSA dynamics in three months. Because of lower urinary tract symptoms, he needed local treatment and underwent radical prostatectomy. A three-month follow-up demonstrated a common post-operative period, mild stress incontinence, and PSAt 0.004 ng/mL. Cystic prostatic carcinoma can manifest as urinary retention and be mistakenly taken for a benign obstructing prostate cyst. Despite the locally advanced tumor, it can be successfully treated locally in highly selected patients.Keywords: prostate cancer, cystic adenocarcinoma, urinary obstruction

Renal emergencies necessitate prompt diagnosis and management to stop active bleeding and retain kidney function. Causes of renal emergencies can be classified into traumatic, atraumatic, iatrogenic, and obstructive etiologies. Interventional radiology (IR) has emerged as an acceptable alternative to surgical treatment in the management of renal emergencies due to its minimally invasive nature. With the rise of interventional procedures, there is a need for further discussion of angiographic and fluoroscopic imaging in the setting of renal emergencies. [ABSTRACT FROM AUTHOR]

A 2-year-old domestic hen was presented for a 15-day history of intermittent left leg lameness. The owners also observed a decrease in egg quality during that period. Physical examination of the bird revealed a generalized weakness with a flattened pale comb. Neurological evaluation of the left leg found a proprioceptive deficit with no loss of pain sensitivity. Whole body radiographic images showed a marked reduction of abdominal detail, a large amount of "grit" (mineral opacity) in the ventriculus, intestinal dilation, and a metallic foreign body (nail) in the digestive tract. Abnormal results from a plasma biochemistry panel were hypercalcemia, hypertriglyceridemia, hyperglobulinemia, hypophosphatemia, increased creatine kinase, and decreased uric acid. After initial stabilization of the patient, a computed tomographic scan was obtained, which revealed multiple right-sided ureteral calculi, the largest of which measured 10 mm in diameter, and changes compatible with cystic right renal nephrosis. Suspected compensatory enlargement of the left kidney was also observed. Considering the renal lesion and associated neurological limb impairment, surgery was recommended and approved by the owner. A right lateral approach was used for the coeliotomy, and a ureterotomy was performed to remove all calculi. Analysis of the ureteral stones confirmed they were 100% uric acid salts. The hen fully recovered left leg function 1 week postsurgery. Urolithiasis is well described in hens, but surgical treatment is uncommon. This report describes the successful removal of ureteral stones by ureterotomy in a domestic hen. [ABSTRACT FROM AUTHOR]

Literature on percutaneous nephrostomy (PCN) placement in pregnant patients is limited. The purpose of this case series of 20 pregnant patients was to report short term maternal and fetal outcomes in this population. A 12-year retrospective study was performed on pregnant patients undergoing PCN. Clinical indications, technical success, maternal outcome, fetal outcome, and complications were obtained from the electronic medical record. Indications for PCN placement included urolithiasis (40%), congenital ureteral dysfunction in the setting of prior ureteral repair (30%), obstruction associated pain (15%), infection (10%), and ureteral injury in the setting of surgery for ovarian torsion (5%). Catheter insertion was successful in all patients (n = 20), with one major complication (urosepsis). Follow up data was available in 19 patients (95%). Catheters were in situ for a median of 82 days. All patients had clinical and symptomatic improvement. Emergency C-sections were required in two cases. Radiation exposure data were available in 15 of 19 patients and revealed a median fluoroscopy time of 2.8 min, median cumulative dose of 43 mGy, and median dose area product of 635 µGy × m2. No adverse fetal outcomes were recorded at time of delivery. PCN placement has good clinical results as a treatment option for ureteral obstruction in a pregnant cohort. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine if male cats treated with 7 days of prazosin following relief of urethral obstruction (UO) experienced decreased rates of recurrent urethral obstruction (rUO) within 30 days vs those treated with 7 days of placebo. Methods: All castrated male cats presenting for the first time with UO from May 2014 to August 2017 were eligible for enrollment. Exclusion criteria included the administration of medications or passage of a urinary catheter prior to referral, the presence of heart disease or hypertension requiring medication, prior treatment with glucocorticoids, non-steroidal anti-inflammatory medications, prazosin or phenoxybenzamine, or radiographic identification of cystoliths. Cats were treated with standardized anesthetic and analgesic protocols, standardized indwelling urinary catheter management, and were hospitalized for care. A random numbers table was generated prior to study initiation and cats were randomized to receive either prazosin (0.5 mg PO q12h for 7 days) or placebo in a blinded fashion. A 30-day follow-up with owners via telephone was performed to identify the rate of rUO. Cats that did not receive the full course of study medication were removed from the analysis. The study was unblinded at the end of data collection. Results: Eighty cats were enrolled and 65 cats completed the study; 12 were excluded because they did not receive the study medication. Sixteen of 65 cats experienced rUO (25%). Of the 16 cats experiencing rUO, five received placebo (n = 5/28 [18%]) and 11 received prazosin (n = 11/37 [30%]). Ten of the cats that experienced rUO reblocked while still hospitalized. There was no significant difference in frequency of rUO in cats treated with prazosin vs placebo (P = 0.27). Conclusions and relevance: Prazosin administered at 0.5 mg PO q12h did not decrease the rate of rUO in this population of obstructed male cats vs placebo. These results further support evidence suggesting that prazosin may not be beneficial in prevention of feline rUO. [ABSTRACT FROM AUTHOR]

Purpose: The diagnosis of xanthogranulomatous pyelonephritis is primarily histological. The mandatory studies that have to be performed are: abdominal echography, excretory urography, CT, and renal angiography. Methods: The current report covers a period of 16 years (1992-2008) and presents clinical material from 9 patients with a long history of nephrolithiasis. In the past, six of them have undergone surgical or extracorporeal lithotripsy. Results and conclusion: The performed preoperative imaging studies showed kidney tumors, and the operative treatment method used was nephrectomy. The post-operative follow-up did not detect any complications in any of these patients.

Copyright of Acta Veterinaria Brasilica is the property of Acta Veterinaria Brasilica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Pyelocaliceal obstruction is a diagnostic challenge, and it is important to identify the obstruction cause. Some patients present extra‐renal compressive masses that need further imagiologic investigation and a biopsy, to establish the diagnosis.

A three-month-old male kid was presented to the Teaching Veterinary Clinical Complex, Pookode, with a history of distended abdomen and difficulty in passing urine, for the past five days. Physical and radiological examination revealed urinary obstruction. Surgical correction was resorted to. Under sedation and local anaesthesia, tube cystostomy was performed with the help of a customised cystostomy cannula. The customised cannula helped quick and easy tube cystostomy with a small incision of skin and muscles. The procedure was less invasive without any complications. The animal recovered uneventfully. [ABSTRACT FROM AUTHOR]

Fetal urinoma is defined as an encapsulated accumulation of extravasated urine within the perirenal space or retroperitoneum. It is an uncommon finding in prenatal practice, and the vast majority of known cases are strongly associated with the existence of a urinary obstruction, such as posterior urethral valves, ureteropelvic junction obstruction, or ureterocele. We report a unique case of prenatally detected fetal bladder urinoma that occurred in the absence of an apparent obstructive uropathy, but was associated with extensive ischemic necrosis and calcifications of adjacent bladder wall, coexistent with signs of vascular supply decompensation. [ABSTRACT FROM AUTHOR]

Abstract Background Urethral obstruction (UO) is a common complication of feline idiopathic cystitis (FIC). Robust treatment recommendations to prevent its recurrence are scarce. Objectives To evaluate meloxicam treatment for prevention of clinical recrudescence in male cats with obstructive FIC. Animals Fifty‐one client‐owned cats. Methods Prospective, randomized clinical trial. Every male cat with FIC‐associated UO was deemed eligible for the study and was recruited during hospitalization. After discharge, cats were treated with phenoxybenzamine and alprazolam for 2 weeks, with (24 cats) or without (27 cats) low‐dose meloxicam (0.025 mg/kg/day PO) and monitored for 6 months. Results Cumulative number (%) of cats with recurrent UO at 10 days, 1‐, 2‐, and 6‐months after discharge was 1 (2%), 2 (4%), 4 (8%), and 8 (16%), respectively. Overall, 12 (24%) cats experienced signs of recurrent FIC within 6 months, with (8 cats) or without (4 cats) concurrent UO. No difference in the cumulative incidence of UO within 6 months was detected with addition of meloxicam (odds ratio [95% confidence interval], 0.63 [0.13‐2.97]; P = .70). All cats were alive at 6 months. Conclusions and Clinical Importance No clinical benefit was detected with the addition of low‐dose meloxicam to phenoxybenzamine and alprazolam treatment for 2 weeks after discharge. Nevertheless, this study was underpowered to identify potential differences, and its findings must be corroborated in larger studies.

Endometriosis presents a diagnostic conundrum due to its diverse clinical manifestations, ranging from asymptomatic to acute obstructive uropathy. This is a case of a 30-year-old woman with a history of endometriosis and rapidly progressing left flank pain culminating in rupture of the renal pelvis in her left kidney. Initial investigations revealed left-sided hydronephrosis without evidence of nephrolithiasis. Subsequent imaging showed active extravasation indicative of urinary obstruction attributable to endometriosis. Placement of a left nephrostomy tube alleviated her symptoms, and follow-up imaging revealed a distal ureteral stricture. A stent was subsequently placed, which resolved the obstruction and obviated the need for extensive surgical intervention. In this case, the patient's history of endometriosis prompted consideration of its role in urinary obstruction, despite the absence of typical symptoms, and underscores the importance of considering endometriosis as a potential cause of acute urinary obstruction, particularly in patients with a history of the disease. Physicians in the emergency department should maintain a high index of suspicion for endometriosis-related complications to facilitate timely intervention and prevent adverse outcomes. Awareness of the variable presentations of endometriosis is paramount for ensuring comprehensive patient care and optimal outcomes., (© 2024 The Authors. Published by Elsevier B.V.)

Purpose of Review: The goal of this paper is to provide the reader with three distinct definitions of midurethral sling failure and provide guidance on the work up and management of each definition. Recent Findings: The definition of sling failure should include not only patients with recurrent and persistent stress urinary incontinence but also those with de novo voiding symptoms and overactive bladder as a result of their midurethral sling. Urodynamics are less commonly performed for the straightforward patient with stress urinary incontinence prior to a midurethral sling. However, there is evidence that urodynamics studies can help with diagnosis and guide management in the patient with a failed midurethral sling. Summary: When a patient experiences abnormalities of urinary storage or emptying after a midurethral sling, a comprehensive workup can help guide thoughtful and effective management of symptoms. [ABSTRACT FROM AUTHOR]

Condyloma acuminate (CA) is a warty lesion caused by human papilloma virus (HPV) mostly involve the external genitalia. A 65-year-old woman with a compliant of acute urinary retention came to our hospital emergency ward and the retention was resolved by placing a 6 Fr Foley catheter. On physical examination warty lesions on patient's urethral meatus was seen and biopsy was taken. The pathology confirmed the diagnosis of CA. 5-FU was prescribed for a month and the outcome was fully satisfactory. To sum up, CA in female with AUR should be kept in mind.

Introduction. The optimal tension of suburethral tape is an important component of effectiveness and safety of the surgery. By now, there is no common standardized guidance on the tensioning of the sling. There is a limited number of publications, devoted to adjustable systems with the ability to correct tape tension in postoperative period. To evaluate the effectiveness of this method, the long-term results of postoperative adjustment of the sling are necessary.Aim. To evaluate the results of complicated stress urinary incontinence (SUI) surgical treatment using a transobturator adjustable sling Urosling (Lintex).Materials and methods. The study included 89 women with complicated SUI. All patients underwent the transobturator adjustable midurethral tape placement. The tension adjustment was performed during 3 days after surgery. Postoperative evaluation included vaginal examination, cough stress test, 1-h Pad-test, uroflowmetry, bladder ultrasound and post-void residual (PVR) urine measurement, validated questionnaires (UDI-6, UIQ-7, ICIQ-SF, PICQ-12) and visual analogue scale (VAS).Results. Mean operative time was 15.74±7.49 min. The tension adjustment was performed in 45.0% (40/89) patients the next day after surgery. On the second day tension re-adjustment was required in 14,6% (13/89) patients. In 3.4% (3/89) women the tension was also tuned on the 3 day. The loosening of the sling was needed in 13.5% (12/89) patients. After adjustment, all patients were continent without any signs of bladder outlet obstruction (BOO). Mean follow-up was 14.3±2.1 months. The objective cure rate was 92.9%. There was no statistically significant difference in the urodynamic parameters. Assessment of patient satisfaction showed that 95.2% (80/84) of the patients were «very» or «very» satisfied.Conclusion. The adjustable transobturator suburethral tape Urosling allows to achieve high effectiveness of treatment in female patients with complicated SUI and to reduce the risk of postoperative BOO development.