Endocervicosis of the Urinary Bladder A Report of Six Cases of a Benign Müllerian Lesion That May Mimic Adenocarcinoma
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Six tumor-like glandular lesions characterized by a prominent component of endocervical-type epithelium involved the wall of the urinary bladder in women of reproductive age (31 to 44 years; mean, 37). All of the lesions posed problems in histologic diagnosis; indeed, a diagnosis of adenocarcinoma was initially rendered in three cases. Five patients presented with bladder symptoms, including—alone or in combination—suprapubic pain, dysuria, frequency, and hematuria. There was catamenial exacerbation of the symptoms in one case. The sixth patient—the only one with documented pelvic endometriosis—presented with dysmenorrhea, dyspareunia, and lower abdominal tenderness. In each patient, a mass that ranged from 2 to 5 cm in maximum dimension was typically located in the posterior wall or posterior dome of the urinary bladder. A partial cystectomy (five cases) or transurethral resection (one case) was performed. In one patient, extravesical pelvic soft tissue was involved, precluding complete resection of the lesion. Microscopic examination revealed extensive involvement of the bladder wall by irregularly disposed, benign-appearing, or mildly atypical endocervical-type glands, some of which were cystically dilated. Other findings included occasional ciliated cells, typically interspersed with the endocervicaltype cells (four cases), a minor component of endometrioid glands (three cases), and glands lined by nonspecific cuboidal or flattened cells with eosinophilic cytoplasm (all cases). Some of the glands were surrounded only by the smooth muscle of the muscularis propria, but in other areas, the periglandular tissue was fibrous or edematous. In three cases, rare glands were surrounded by thin rims of endometriotic stroma. Gland rupture resulted in stromal extravasation of mucin in all cases and was a prominent feature in one. All patients had uneventful postoperative follow-up periods ranging from 1.5 to 14 years. The findings indicate that these bladder lesions are müllerian in nature and represent examples of endocervicosis, the mucinous analogue of endometriosis. Awareness of the lesion, which with one possible exception is hitherto undescribed in the bladder, and attention to its typical histologic features should facilitate its crucial distinction from adenocarcinoma.Keywords:
Dysuria
Objective： To study the reason of dysuria after operation for benign prostate hypertrophy.Methods:The clinic information of 26 cases in the dysuria for benign prostate hypertrophy was analyzed.Results:The catheterization、 dilatation of urethral stricture、 TURP were used in the 23 cases,and the dysuria got better.Conclusions： The reason of dysuria was thought over in treatment,dilatation of urethral stricture and TURP were the best way to cure the dysuria.
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Diagnosing urinary infection in patients with chronic lower urinary tract symptoms without dysuria is a critical step. In this study we scrutinize the sensitivity and specificity of dipstick urinalysis and microscopic pyuria (10 or more white blood cells per microl) to identify infection in such patients.This was a prospective, blinded, observational cohort study of urological outpatients with painless lower urinary tract symptoms. Midstream and catheter urine samples were analyzed. A total of 508 midstream urine samples were used to compare leukocyte esterase, nitrite dipstick and urine microscopy with cultures seeking 10(5) cfu/ml. Similarly 470 catheter urine samples were used to compare the same surrogates with 10(5) cfu/ml and with an enhanced culture method seeking 10(2) cfu/ml. A comparison of leukocyte esterase against microscopic pyuria was made using the 508 midstream and 470 catheter specimens of urine. Midstream urine specimens were provided by 42 normal volunteers for comparison.For a midstream urine culture at 10(5) cfu/ml leukocyte esterase was 56% sensitive, nitrite was 10% sensitive and microscopic pyuria was 56% sensitive. Specificities were 66%, 99% and 72%, respectively. For a catheter specimen of urine culture at 10(5) cfu/ml leukocyte esterase was 59% sensitive, nitrite was 20% sensitive and microscopic pyuria was 66% sensitive. Specificities were 84%, 97% and 73%, respectively. The enhanced culture of catheter specimen of urine at 10(2) cfu/ml was positive in 29% of patients vs 15% at 10(5) cfu/ml.Despite official guidelines and widespread use these tests cannot be considered appropriate for diagnosing urinary tract infection in patients with lower urinary tract symptoms, and should be abandoned in this context.
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Primitive neuroectodermal tumor (PNET) arising in the urinary bladder is extremely rare. Here, we report a case of primary PNET of the urinary bladder in an aged Asian man that showed an aggressive clinical course. A 74-year-old man presented with frequency, dysuria, and gross hematuria. Pelvic computed tomography showed a mass in the urinary bladder. Microscopically, the tumor revealed sheets of uniform, small, round, blue cells, and immunohistochemical examination demonstrated primary PNET of the urinary bladder. Palliative chemotherapy was administered. After three courses of chemotherapy, his disease progressed and he died 4 months after diagnosis.
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Primitive neuroectodermal tumor
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A postal questionnaire was used in a survey of dysuria in women aged 20-54 years in four London general practices. Twenty per cent of all women reported dysuria in the previous year (recent dysuria) and half of these women suffered at least one further episode in the same year. The prevalence of recent dysuria showed a decline with increasing age, a small increase with increasing number of pregnancies, no social class effect and no difference with marital status. Frequent recent episodes were more likely in women whose first reported episode of dysuria occurred before the age of 20 years. The risk of dysuria occurring in any pregnancy was about 12 per cent, and a small group - about 6 per cent of those who had had more than one pregnancy - reported dysuria in every pregnancy. Comparison of the practice records of non-responders and responders suggested that the true prevalence of recent dysuria was over-estimated by about one third. The routine use of a few specific questions in clinical and epidemiological practice may help to identify those women at increased risk from urinary tract infection, particularly in pregnancy.
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Urinary tract infections are considered to be one of the most common bacterial infection in children. In 30 % of children with anomalies of urinary tract , urinary tract infection (UTI) can be the first sign. UTIs are classified according to site, symptoms or episode. E. coli is responsible for 80-90 % of acute pyelonephritis episodes. Symptoms include fever, dysuria, tenderness in the lower abdomen are typical for older children, whereas for younger are non-specific. Diagnosis is based on clinical symptoms, abnormal urine analysis and growth on urine culture. Urine culture is still a gold standard for diagnosing urinary tract infections. Antibiotics are usually effective, although antibiotics resistance is still an increasing problem.
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Obiective To research the pathogenesis,prevention and treatment methods of dysuria after suprapubic prostatectomy.Method In order to reduce the incidence of the dysuria,the pathogenesis,prevention and treatment of 18 cases of postoperative dysuria are studied by cases analysis.Results In 18 patients with dysuria,the pathogenesis of dysuria consisted of stricture or adhesion of bladder neck(8 cases),urethral stricture(6 cases),prostatic tissue remanits(4 cases).With treatment and reloperation,17 cases were cured,one cases were improved.[WT5”HZ〗Conclusion The dysuria results mainly from iatrogenic factors.It would be avioed if doctors had learned the pathogenesis before operation. [WT5”HZ〗
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Objective:Explore nursing interventions of The hemorrhoids postoperative dysuria prevent urinary retention.Method:To 360 cases of tumors in postoperative dysuria patients were randomly divided into observation group and the control group and observation group for analyzing the causes of dysuria, take corresponding nursing measures,the control group given routine care.Result:Observation group dysuria symptoms,6 cases of urinary retention urethral catheterization. The control group 24 cases of urinary retention urethral catheterization,the clinical curative effect of observation group was obviously better than the control group,two groups compare the difference was statistically significant (P 0.05).Conclusion:Analysis of the causes of dysuria and targeted measures,can reduce hemorrhoids postoperative dysuria and the incidence of urinary retention and reduces suffering.
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Objective To investigate the experience and clinical significance of urodynamics analysis of dysuria in females.Methods Fifty-three female patients with dysuria were evaluated with complete routine urodynamics.Results Of the 53 female patients with dysuria,13 were neurogenic bladder,21 were detrusor underactivity,9 were primary bladder neck obstruction 3 were unstable bladder,5 were detrusor underactivity combined with bladder neck obstruction,and 2 were norma1.Conclusion The urodynamics examination should be an essential examination for female patients with dysuria.It can provide the objective causes of dysuria and it is of great importance for the clinical therapy.
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