Bladder Ganglioneuroma: A Rare Case Report


Ganglioneuromas are neurogenic tumors that often stem from sympathetic ganglion cells, and less frequently from the adrenal medulla and peripheral nerves. These tumors are slow-growing and have a more benign character compared to other cell types. Herein we present a pure ganglioneuroma of a 50-year-old male patient as the third case reported in the urinary bladder. At cystoscopy a 6 cm x 6 cm tumor was found on the posterior wall of the bladder and resected. Histologically, the tumor was composed of mature and immature ganglion cells and Schwann cells. Since the neuroblasts did not consist of an evident bundle structure, it was diagnosed as a ganglioneuroma. To our knowledge, 5 cases of composite paraganglioma-ganglioneuroma have been reported in the English literature. However, there are only 2 documented cases of bladder-located, pure ganglioneuromas. 

Kemal Ener, Mustafa Aldemir, Emrah Okulu, Aylin Kilic Yazgan, Murat Keske, Fatih Akdemir, Muhammet Fuat Özcan

Submitted April 1, 2013 - Accepted for Publication May 17, 2013

KEYWORDS: Ganglioneuroma, urinary bladder

CORRESPONDENCE: Dr. Kemal Ener, Ataturk Education and Research Hospital Urology Clinic, 06610, Ankara, Türkiye ()

CITATION: UroToday Int J. 2013 June;6(3):art 38.


A Prospective Evaluation of the AJUST® Single-Incision Sling in the Surgical Treatment of Stress Urinary Incontinence: Two Years of Follow-Up


Introduction: The mid-urethral sling has become the mainstay in the surgical management of stress urinary incontinence. Early meta-analyses suggested that the obturator approach (TOT) may be preferable in women with a high body mass index (BMI), concomitant voiding difficulties (VD), mixed urinary incontinence (MUI), or previous retropubic surgery. However, they are associated with increased and prolonged de novo groin pain. The AJUST® single-incision sling (SIS) was developed as an alternative to the retropubic and obturator slings and has been shown to be an effective treatment for urodynamic stress incontinence (USI) in the short term. We aim to assess if the AJUST® SIS would be an effective alternative to the TOT in a cohort of patients who have urodynamic stress incontinence (USI) with concomitant detrusor overactivity (DO), VD, high BMI, or those with previous retropubic surgery.

Methods: Women with USI and either concomitant DO, VD, previous failed TVT, or a BMI > 35 underwent treatment with the AJUST® SIS. Women were asked to complete the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and an Urgency Perception Scale (UPS) preoperatively and then at 6 weeks, 6 months, 12 months, and 24 months postoperatively along with the PGI-I form. The numerical rating scale (NRS) was used to score pain 3 hours postoperatively and prior to discharge. Changes in ICIQ-UI-SF and UPS scores were measured.

Results: Twenty-five women were recruited. The mean age was 58 years. Of these, 28% had USI and 72% had mixed incontinence. There were no major perioperative complications. Mean postoperative pain scores were low with no de novo groin pain. All women had satisfactory postoperative voiding and a negative cough stress test at 6 weeks of follow-up. At the 2-year follow-up, 89% had still improved.

Conclusion: The AJUST® SIS appears to have promising medium-term efficacy in this challenging cohort of women. The long-term results are awaited.

Fida Al-Asali, Alexander Goodman, Ismaiel Abu Mahfouz, Christian Phillips

Submitted April 2, 2013 - Accepted for Publication April 24, 2013

KEYWORDS: Stress urinary incontinence, retropubic sling, transobturator sling, AJUST® sling

CORRESPONDENCE: Ismaiel Abu Mahfouz, Consultant Obstetrician and Gynecologist, Jordan Healthcare Center, Amman, Jordan ()

CITATION: UroToday Int J. 2013 June;6(3):art 36.


The Feasibility of Navigation-Assisted Mapping of Bladder Tumors During Transurethral Resection


Introduction: Surgical navigation systems have proven to support surgeons to localize and target anatomical structures. The aim of this study is to investigate the accuracy of reproducing bladder coordinates during transurethral resection using an optical navigation system, as a first step to assess the feasibility of accurate navigation-assisted resection of bladder tumors.

Methods: The coordinates of 21 bladder locations in 7 patients were collected using a Medtronic StealthStation Surgical Navigation System with infrared optical tracking. The coordinates of bladder lesions and ureteral orifices were recorded twice, independently, after filling the bladder with an arbitrary fixed volume of 390 mL of saline.

Results: The distance, in millimeters, between the coordinates of 2 consecutive measurements of the same bladder location was calculated. Bladder lesions and ureteral orifices could be retrieved with a mean accuracy of 8.2 mm (SD = 6.2; N = 21).

Conclusion: Navigation-assisted mapping of the bladder showed to be accurate at constant bladder volumes. Further development of the technology is needed to improve navigation efficiency and to implement augmented reality techniques to facilitate the retrieval of bladder tumors during transurethral resection.

Ronald O.P. Draga, Herke Jan Noordmans, Tycho M.T.W. Lock, Joris Jaspers, Arjen van Rhijn, J.L.H. Ruud Bosch

Submitted February 21, 2013 - Accepted for Publication April 24, 2013

KEYWORDS: Urinary bladder neoplasms, computer-assisted surgery, cystoscopy, residual neoplasm, recurrence

CORRESPONDENCE: Ronald Oskar Draga, M.D., Department of Urology, University Medical Center, Utrecht, Utrecht, Netherlands ()

CITATION: UroToday Int J. 2013 June;6(3):art 35.


Kidney and Prostatic Abscesses Secondary to Burkholderia Cepacia: A Unique Constellation in an HIV-Positive Male


We report the first case of Burkholderia cepacia infection leading to multiple kidney abscesses and concomitant prostatic abscess in a human immunodeficiency virus (HIV)-positive 21-year-old male. The patient initially presented with generalized abdominal pain, and computed tomography (CT) demonstrated left renal micro-abscesses. A follow-up CT scan demonstrated worsening of the kidney abscesses and a cystic lesion in the right prostate gland suggestive of an abscess. Transrectal ultrasound guided drainage of the abscess was followed by transurethral resection of the prostatic abscess. All clinicians need vigilance and an open-mind when investigating etiologies for infectious disease processes in HIV-positive patients. 

Zachary Klaassen, Young Kwak, Derrick L. Johnston, Jeffrey M. Donohoe, Martha K. Terris

Submitted January 28, 2013 - Accepted for Publication April 22, 2013

KEYWORDS: Burkholderia cepacia, granulomatous prostatitis, HIV, kidney abscess, prostate abscess

CORRESPONDENCE: Zachary Klaassen, M. D., Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, Augusta, Georgia 30912 ()

CITATION: UroToday Int J. 2013 June;6(3):art 34.


Ultrasound versus Fluoroscopic Complete Supine Percutaneous Nephrolithotomy: A Randomized Clinical Trial


Introduction: To compare complications and outcomes of totally ultrasonic versus fluoroscopically guided complete supine percutaneous nephrolithotomy (csPCNL).

Materials and Methods: In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance (group A), and the other 25 patients underwent fluoroscopically guided csPCNL (group B). Statistical analysis was performed with SPSS 16 software.

Results: The mean BMI was 28.14 in group A and 26.31 in group B (ρ = 0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (ρ = 0.20). The stone-free rate was 88.5% and 75.5% in groups A and B, respectively (ρ = 0.16). Overall, 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (ρ = 0.11). The mean operative time in groups A and B were 88.46 and 79.58 minutes, respectively (ρ = 0.39). The mean hospital stay was 69.70 and 61.79 hours in groups A and B, respectively (ρ = 0.22).

Conclusion: Totally ultrasonic had similar outcomes to fluoroscopic csPCNL in selected cases. Ultrasonography can be an alternative to fluoroscopy in csPCNL.

Siavash Falahatkar, Aliakbar Allahkhah, Majid Kazemzadeh, Ahmad Enshaei, Maryam Shakiba, Fahimeh Moghaddas, Mohammad Allahkhah

Submitted March 27, 2013 - Accepted for Publication May 5, 2013 

KEYWORDS: Percutaneous nephrolithotomy, supine, ultrasound, fluoroscopy, complete supine, csPCNL

CORRESPONDENCE: Aliakbar Allahkhah, M.D., Urology Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Islamic Republic of Iran ()

CITATION: UroToday Int J. 2013 June;6(3):art 33.


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