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An BR, Gao C, An D. Pelvic Abscess Caused by Ureteral Calculus and Abscess Treatment through Aspiration by Transperineal Puncture. Case Rep Urol 2024; 2024:1723185. [PMID: 38303899 PMCID: PMC10834087 DOI: 10.1155/2024/1723185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Abstract
Pelvic abscess is mostly caused by gynecological inflammation or digestive system diseases such as appendicitis or Crohn's disease. This case of pelvic abscess originates from ureteral calculus and is not commonly seen in clinical practice. This is mainly due to the patient's ureteral stones not being actively treated. After local puncture and pus extraction, as well as the application of effective antibiotics, the patient recovered. Therefore, this case provides clinical doctors with experience that ureteral stones may cause serious complications and should be actively treated after detection.
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Affiliation(s)
- Bo-Ran An
- Gastroenterology Department, Affiliated Hospital of Hebei University, No. 212 Yuhua East Road, Baoding, Hebei Province 071000, China
| | - Chao Gao
- 2nd Ward, Department of Urology, Affiliated Hospital of Hebei University, No. 212 Yuhua East Road, Baoding, Hebei Province 071000, China
| | - Di An
- Department of Neurology, Affiliated Hospital of Hebei University, No. 212 Yuhua East Road, Baoding, Hebei 071000, China
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Tariq A, Stewart AG, Desai DJ, Britton S, Dunglison N, Esler R, Roberts MJ. Periurethral abscess etiology, risk factors, treatment options, and outcomes: A systematic review. Curr Urol 2023; 17:100-108. [PMID: 37691985 PMCID: PMC10489258 DOI: 10.1097/cu9.0000000000000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/23/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives This study aimed to describe patterns of presentation, etiology, risk factors, management, and treatment outcomes of periurethral abscesses using a systematic review framework. Materials and methods After prospective registration on the PROSPERO database (CRD42020193063), a systematic review of Web of Science, Embase, PubMed, and Cochrane scientific databases was performed. Articles published between 1900 and 2021 were considered. Extracted data included symptoms, etiology, medical history, investigations, treatment, and outcomes. Collated data were analyzed using univariate methods. Results Sixty articles met the inclusion criteria reporting on 270 patients (211 male, 59 female) with periurethral abscess. The most common clinical features were pain (41.5%), pyuria (41.5%), dysuria (38.5%), urinary frequency (32.3%), fever (25%), and a palpable mass (23%). Predisposing risk factors included the presence of a sexually transmitted infection or urinary tract infection (55.0%), urethral strictures (39.6%), and recent urethral instrumentation (18.7%). Management approaches included open incision and drainage (64.3%), conservative management with antibiotics (29.8%), and minimally invasive techniques (needle aspiration, endoscopic drainage). Time trend analysis of etiology revealed a decreased incidence of infection (sexually transmitted infection/urinary tract infection, human immunodeficiency virus) and higher incidence of diabetes mellitus and periurethral bulking injections in recent years. Conclusions Periurethral abscesses may display a wide range of clinical features. Presentation, risk factors and underlying etiology vary with sex. The optimal management technique is guided by abscess size. Open incision and drainage combined with antibiotics continues to be the mainstay of management. However, minimally invasive techniques are gaining favor. To the authors' knowledge, this is the first systematic appraisal and management algorithm for periurethral abscess.
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Affiliation(s)
- Arsalan Tariq
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Adam G. Stewart
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Devang J. Desai
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Toowoomba Base Hospital, Toowoomba, QLD, Australia
| | - Sumudu Britton
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Nigel Dunglison
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Rachel Esler
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Matthew J. Roberts
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
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Abstract
Female urethral diverticula are rare, benign epithelium-lined outpouchings of the female urethra. Patients can present with a multitude of symptoms, most commonly urinary incontinence, recurrent UTIs and dyspareunia. These presenting symptoms are often confused with other diagnoses leading to delayed diagnosis or misdiagnosis. Diagnosis and preoperative assessment of bladder function is most accurate using a combination of clinical examination, T2-weighted postvoid MRI and videocystometrography. Best treatment is by vaginal excision, a procedure with a very low recurrence rate and high patient acceptability. Excision also results in high cure rates for associated dyspareunia, UTI and voiding dysfunction. Pre-existing urodynamically proven stress urinary incontinence (USUI) resolves in 50% of patients after excision of the diverticulum with Martius labial fat pad interposition without the need for further treatment. Potential adverse effects after surgery are new-onset USUI, urethrovaginal fistula and urethral stricture. The rate of onset of these potential adverse effects is low and related to the preoperative appearance of the diverticulum on an MRI scan and the complexity of the diverticulum.
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Affiliation(s)
- Tamsin J Greenwell
- Department of Urology, University College London Hospital, Ground Floor North, 250 Euston Road, London NW1 2PG, UK
| | - Marco Spilotros
- Department of Urology, University College London Hospital, Ground Floor North, 250 Euston Road, London NW1 2PG, UK
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