[Incrusted cystitis with isolation of Corynebacterium group D2]

Three cases of encrusted cystitis caused by Corynebacterium group D2 are described. The vesical damage previous to the establishment of this bacteria is noteworthy and the very rapid increase in urease activity explains the pathogenesis of the situation. Thus allowing for its identification and is relevant to treatment. Cloudy urine with a strong smell of ammonium, alkaline pH and crystals of ammonium magnesium phosphate in the sediment will bring this microorganism and its characteristic growth pattern to mind thus avoiding a falsely negative report. Treatment combining an antimicrobial agent and cystoscopic resection of the encrusted stones, where Corynebacterium group D2 has lodged, has proved efficacious. Vancomycin and teicoplanin have always been active and are eliminated through the kidneys.

Effect of therapy on susceptibility to urinary tract infection in male cats with indwelling urethral catheters

Indwelling urinary catheters with a closed urine collection system were maintained in 30 male cats for 3 days after induction of irritant cystitis. All cats received subcutaneous fluids during the 3 days the catheters were in place. The effects of four different treatment regimens on urinary tract infection rates, incidence of urethral obstruction, and development of urinary tract lesions over a 10-day period were compared with results in a nontreated group. Treatments were 1) amoxicillin for 5 days PO; 2) prednisolone for 5 days PO; 3) both amoxicillin and prednisolone for 5 days PO; and 4) dimethylsulfoxide (DMSO) for 3 days intravesicularly. Euthanasia was done before the end of the 10-day experimental period if the cats had two bouts of urethral obstruction or if the cats became uremic for causes unrelated to urethral obstruction. Seven cats were euthanatized before the conclusion of the experiment. These cats had been treated with prednisolone, prednisolone and amoxicillin, or DMSO. All cats that received amoxicillin alone or no therapy survived the 10-day period. Mortality was due to repeated urethral obstruction or to uremia associated with pyelonephritis or papillitis. Urinary tract infection rate was similar in all groups. The group treated with prednisolone alone had the highest incidence of renal infection. Inflammatory lesions in the lower urinary tract were similar in all groups. In conclusion, persistent urinary tract infection often develops in cats with cystitis after indwelling urethral catheterization even when closed systems of urine drainage are used.(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent eosinophilic cystitis: a case responsive to steroids

We report a case of eosinophilic cystitis that was responsive to prednisone but that recurred when the drug was withdrawn. The cause of eosinophilic cystitis remains an enigma but it probably represents a form of allergy. Investigation of etiology and therapeutic options are discussed.

Hemorrhagic cystitis with herpes simplex virus type 2 in the bladder mucosa

A 67-year-old woman who had underlying rheumatoid arthritis and diabetes mellitus had an 8-year history of recurrent hemorrhagic cystitis. During her most recent episode of cystitis, a specimen of urine yielded herpes simplex virus type 2 in culture. A biopsy of the bladder mucosa revealed intranuclear inclusions in multinucleated and mononuclear giant cells that were positive for herpes simplex virus type 2 by immunoperoxidase staining. She had no evidence of infection with herpes simplex virus outside her bladder.

Pelvic pain without pelvic organs

We report on 4 patients with persistent, severe pelvic pain unresponsive to removal of the bladder, uterus, ovaries and fallopian tubes. Of the patients 3 had a diagnosis of interstitial cystitis and 1 had voiding dysfunction. We conclude that severe pelvic pain may not be responsive to the elimination of pelvic organs and alternative organ-preserving therapies should be considered.

Acute renal failure in adults with uncomplicated acute pyelonephritis: case reports and review

Acute renal failure is a rare complication of acute pyelonephritis in patients who do not have urinary obstruction. Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure nor is renal failure considered a likely consequence of bacteriuria. In this review, the cases of acute renal failure caused by acute pyelonephritis that have been reported in the last quarter century are examined. Including two new cases reported, only 12 cases of acute pyelonephritis resulting in acute renal failure were found. Three of these occurred in patients with a solitary kidney. All cases occurred in individuals who had no history of urinary tract infections, and all were caused by Escherichia coli. In several cases, the administration of non-steroidal antiinflammatory drugs contributed to disease. Three cases occurred after catheter-acquired bacteriuria. Acute renal failure is an uncommon but serious consequence of uncomplicated acute pyelonephritis in adults.

Sperm quality in men with chronic abacterial prostatovesiculitis verified by rectal ultrasonography

Semen analyses were performed on 50 men with chronic abacterial prostatovesiculitis (CPV) and 25 asymptomatic control subjects. All subjects had had symptoms of at least three months' duration, and the diagnosis was verified by rectal ultrasonography and after microbiologic culture of seminal plasma. Fifty-eight percent had increased concentrations of leukocytes (greater than 1 x 10(6)/mL) in the ejaculate compared with 15 percent in the controls. Only 10 percent of the CPV subjects could be classified as normospermic compared with 60 percent in the controls. The incidence of severe disturbances in sperm quality and azoospermia was also four times greater in the CPV group. Neither the degree of leukospermia nor the ultrasonographic findings could predict the extent of the disturbance in sperm quality.

Clear cell dysplasia of the bladder. Report of a case with flow cytometric analysis

Clear cell dysplasia of the bladder is a well-described morphologic entity that has been found in association with transitional cell carcinoma of the bladder. Its biologic role in bladder tumorigenesis is unknown, and no instances of its polidy analysis have been reported. The authors describe a case of clear cell dysplasia of the bladder found in association with a primary adenocarcinoma of the bladder. Flow cytometric analysis of bladder tissue involved by clear cell dysplasia, adenocarcinoma and cystitis cystica (all from the same bladder) demonstrated no DNA aneuploid populations. Cells from the area of clear cell dysplasia had an S + G2 + M fraction of 7%, indicating that it was a proliferative lesion. Cells from the adenocarcinoma had an S + G2 + M phase of 18%, and cells from an area of cystitis cystica had an S + G2 + M phase of 4%.

Mesna versus hyperhydration for the prevention of cyclophosphamide-induced hemorrhagic cystitis in bone marrow transplantation

Hemorrhagic cystitis is a major complication of high-dose cyclophosphamide therapy used in preparation for allogeneic or autologous bone marrow transplantation. Although previous reports had suggested that the sulfhydryl-containing compound mesna might be superior to forced diuresis in preventing hemorrhagic cystitis, there were concerns about the effect of mesna on engraftment in these studies. To address these concerns, 100 patients were randomized to receive mesna or forced saline diuresis while undergoing bone marrow transplant conditioning with regimens that included high-dose cyclophosphamide. To try to minimize the likelihood of graft rejection, patients who were being transplanted with cyclophosphamide as a sole agent were excluded from the study. After randomization and administration of therapy, patients were monitored by microscopic and dip-stick urinalyses; they were also followed for effects of therapy on engraftment. The incidence of consistent or severe hematuria was 33% in the mesna arm and 20% in the hyperhydration arm (P = .31). Severe bleeding occurred in 12.5% of mesna patients and 7.5% of hyperhydration patients (P = .71). No unexpected toxicities were encountered, and engraftment times did not differ. Based on this randomized trial of 100 patients, we conclude that mesna and hyperhydration are equally effective in preventing cyclophosphamide-induced hemorrhagic cystitis in bone marrow transplantation patients.

Nephrogenic adenoma with bladder exstrophy and immunosuppression

Nephrogenic adenoma, an unusual proliferative lesion, often occurs in association with chronic inflammation of the bladder and is rarely found in children. Two cases are reported, one occurring in a young child born with bladder exstrophy, and one in a young female, with both interstitial cystitis and chronic use of immunosuppressive therapy. We believe these are the first case reports of nephrogenic adenoma occurring in this specific clinical setting.

Colovesical fistula secondary to vesical gangrene in a diabetic patient

We present a case of colovesical fistula secondary to vesical gangrene. Precipitating factors were diabetes and vesical distension caused by the obstruction of an indwelling catheter. This complication is an exceptional outcome in gangrenous cystitis and it requires emergency surgical treatment.

[Intestinal perforation after treatment of radiation cystitis using the neodymium:YAG laser]

Female patient with multiple episodes of pelvic surgery and with radical cystopathy, treated by Neodymium: YAG laser photocoagulation with haemostatic purposes. During the post-operative she developed intestinal perforation with fatal evolution. The cases described on this serious and infrequent complication of laser endovesical application are reviewed, commenting the technical and anatomical elements that justify it.

[Pelvic lipomatosis associated with cystitis glandularis--case report]

Pelvic lipomatosis is a rare benign disease of unknown etiology characterized by the proliferation of infiltrating fatty tissue within the deep bony pelvis. These fatty tissue may enclose the pelvic and retroperitoneal organs and various degrees of luminal compression and obstruction may happen. There is no typical presenting symptoms of pelvic lipomatosis. The major diagnostic methods are radiological examinations. CT scan is the definitive test to confirm the diagnosis. Open biopsy may be necessary when the diagnosis is inconclusive. Various treatment modalities have been tried, but only the diet therapy and complete ablation of fatty tissue ever reported to be successful. Cystitis glandularis, a rare proliferative inflammatory disease of the bladder, is reported to occur concurrently with pelvic lipomatosis in a patient. Herein we report a similar case. A middle-aged male patient was admitted with the chief complaint of painless gross hematuria for two weeks. After admission a series of radiological examinations and endoscopic bladder biopsy were performed. He was proved to be a rare case of pelvic lipomatosis associated with cystitis glandularis.

[Peritonitis as complication of cysto-uretero-pyelonephritis in a cow]

A Holstein-Friesian heifer had shown a haemorrhagic discharge from the vulva since three days. The animal had delivered a calf nine months previously and was seven months pregnant. On admission, haemorrhagic fluid was obtained by catheterisation from the urinary bladder and by paracentesis from the abdominal cavity. At autopsy, bilateral cysto-uretero-pyelonephritis, associated with peritonitis, was observed. A perforation of one of the lobules of the right kidney was believed to be the cause of the peritonitis. The vesicoureteral reflux might have been enhanced by the presence of polyps in the urinary bladder.

The use of vidarabine in the treatment of human polyomavirus associated acute haemorrhagic cystitis

The human BK and JC polyomaviruses are known to be reactivated and excreted in the urine following bone marrow transplantation (BMT). A proportion of patients who excrete BK virus following BMT experience a haemorrhagic cystitis (HC), which may persist for many months. We report a case of human polyomavirus-associated HC, in whom treatment with vidarabine was associated with a dramatic response.

Eosinophilic cystitis in children

Eosinophilic cystitis is an uncommon inflammatory disorder of the urinary bladder which causes irritative voiding symptoms and may mimic rhabdomyosarcoma radiographically. In children, eosinophilic cystitis has been previously reported to be self-limiting and requires no specific therapy. Reported herein is a case of a nine-year-old girl in whom eosinophilic cystitis recurred following antireflux surgery, raising the question of an association of eosinophilic cystitis with local trauma such as bladder surgery. Consideration should be given to pretreatment with steroids and antihistamines prior to surgery in these patients.

High serum aluminium levels and acute reversible encephalopathy in a 4-year-old boy with acute renal failure

We report a 4-year-old boy, in acute renal failure, who had acute encephalopathy with very high serum aluminium levels (135 micrograms/l [5 mumol/l]) after receiving vesical irrigations with alum. We believe that in situations of non-focal neurological deterioration with no apparent cause in patients with impaired renal function receiving aluminium-containing preparations, the possibility of acute aluminium poisoning should be considered.

Cystitis glandularis occurring in neurofibromatosis

A case of cystitis glandularis occurring concurrently with a neurilemmoma of low malignant potential in a patient with neurofibromatosis is presented. The co-existence of these two conditions made it difficult to distinguish between local recurrence of the neurilemmoma and malignant change in the cystitis glandularis. Repeated biopsies were required to solve this problem. The pathological and radiological features are described.

[Patent urachus associated with abdominal abscess: report of a case]

A case of the patent urachus associated with abdominal abscess was reported. A 44-year-old woman was consulted to our clinic with the complaints of bladder irritability and discharge from the navel on October 27, 1987. A fist-sized tumor around the umbilicus was pointed out and the cystography from the umbilicus demonstrated that the contrast medium reached to the urinary bladder. The cystoscopy showed the protruded lesion on the dome of the bladder. The pre-operative diagnosis was patent urachus. She received resection of the urachus on November 11, 1987. The pathological finding was pyogenic granuloma of the urachus due to chronic inflammation.

Open randomized controlled parallel study of ofloxacin versus trimethoprim-sulfamethoxazole treatment of lower respiratory tract and urinary infections

A total of 60 patients with lower respiratory tract or urinary tract infections were enrolled in an open, randomized, controlled, parallel study comparing 300 mg ofloxacin (OFX) b.i.d. with trimethoprim + sulfamethoxazole (TMP 800 mg + SMX 160 mg), 1 tablet, b.i.d. The signs and symptoms of low respiratory tract infection were cured in 12 patients (80%) of the OFX group and improved in 2 other patients (13%); at the end of therapy, the 2 germs that persisted were Streptococcus pneumoniae and Branhamella catarrhalis. Clinical cure was achieved in 13 patients (86%) in the TMP-SMX group, while 2 patients were considered as failures (14%); after therapy, the 3 organisms that persisted were 2 S. pneumoniae and 1 Pseudomonas aeruginosa. As far as urinary tract infections are concerned clinical cure and complete eradication of bacteria were achieved in 14 patients in the OFX group (93%); the germ that persisted was Escherichia coli (100,000 CFU), but the patient was asymptomatic. In patients of the TMP-SMX group the urinary infections were cured in 11 subjects (73%); the germs that persisted were 2 E. coli and 1 Proteus mirabilis. Adverse effects were reported for 3 patients (10%) in the OFX group and 4 patients (13%) in the TMP-SMX group. The measurement of serum and intracellular (polymorphonuclear cells and lymphocytes) levels of OFX and TMP-SMX and the assessment of the host's immunocompetence ruled out the possibility of any immunotoxicological side effect.

[A case report of eosinophilic cystitis complicated with transient vesicoureteral reflux]

A case of eosinophilic cystitis complicated with transient vesicoureteral reflux in an 11-year-old girl with allergic disorders is reported. She was suffering from pollakisuria, painful urination, vesical irritability, and gross hematuria for about 2 months. Urinalysis showed aseptic pyuria. White blood cell count was 9,700/mm3 with eosinophils of 10%. Eosinophils were also found on urine cytology. Intravenous pyelography revealed bilateral hydronephrosis and apparently contracted bladder. Tumorous lesion and edematous mucosa were observed in the retrotrigonal region on cystoscopy. The multiple bladder biopsy uniformly revealed eosinophilic cystitis. Following antiallergic treatment, practically all symptoms subsided in steps, and normal cystoscopic appearance and histological structure were restored in 3 months. The vesicoureteral reflux markedly diminished in 10 months.

Spontaneous remission from acute exacerbation of chronic adult T-cell leukemia

Spontaneous remission without any anti-cancer therapy in a 57-year-old woman with adult T-cell leukemia (ATL) is reported. The patient was referred to our department because of persistent cough and appearance of abnormal lymphocytes in the peripheral blood, and she was diagnosed as having chronic ATL. Eight months later, she was re-admitted because of cystitis, watery diarrhea and worsening of respiratory symptoms with an increase of ATL cells (WBC 31 x 10(9)/l with 56% ATL cells). Acute exacerbation of ATL was diagnosed. Interestingly, antibiotic therapy for the pulmonary and urinary tract infections brought about spontaneous reduction of the ATL cell count. Spontaneous remission of ATL continued for one year without chemotherapy. The role of infection as a trigger of acute exacerbation and spontaneous remission of ATL is discussed.