1/10. A sensitive bladder: an atypical presentation of cancer in a U.S. Army pilot.Bladder cancer is the most common cancer in the urinary tract, the vast majority (90%) of which are transitional cell carcinomas. A papilloma (grade I) lesion offers an excellent prognosis after excision, though recurrence is possible. The classic sign of bladder cancer is gross, painless hematuria. We report a case of transitional cell papillary carcinoma in an aircrew member with atypical presentation: irritative voiding symptoms without hematuria. With a careful history and physical, and aggressive clinical suspicion, an early diagnosis was made offering an excellent prognosis. The patient, an Army helicopter pilot, returned to flight status with a waiver.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Chronic perineal pain and lower urinary tract dysfunction--a clinical feature of the "gulf war syndrome"?A Persian gulf war veteran presented to the University Neuro-urology service for management of severe chronic perineal pain. The overall physical and neurological exam was unremarkable. However, the rectal exam and the urodynamic study revealed a severe pelvic floor dysfunction. A neuro-behavioral approach is recommended and discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. endometriosis presenting as a urethral diverticulum: a case report.BACKGROUND: pelvic pain is a common complaint among women of childbearing age. It has an extensive differential diagnosis that at times can make it difficult to determine its etiology. One must therefore rely on the characteristics of the physical examination, symptoms and imaging studies. However, in doing so, one should keep in mind that many diseases mimic one another. physicians must be careful not to fall into the trap of simply assigning a specific disease to a given group of symptoms. CASE: A 35-year-old woman, gravida 2, para 0020, presented to a clinic complaining of left lower abdominal pain. She had a history of dyspareunia, dysmenorrhea, urinary frequency and numerous urinary tract infections. Previous laparoscopies had been negative for endometriosis. Physical examination demonstrated a 1.5-cm mass left of the midurethra. No pus was expressed through the urethra with cyst massage. Imaging showed a 1.1 x 1.1-cm lesion in the left posterolateral aspect of the urethra consistent with a urethral diverticulum. Uterine adenomyosis was also noted. Although clinical symptoms, physical examination and imaging suggested a urethral diverticulum, a vaginal endometriotic cyst was encountered at surgery. Pathologic evaluation of the surgically excised lesion revealed endometriosis, revealed endometriosis. CONCLUSION: In this case, clinical findings, location and imaging characteristics of a periurethral endometriotic lesion suggested a urethral diverticulum. endometriosis should be considered in patients with a history of pelvic pain who present with urinary frequency and a periurethral lesion.- - - - - - - - - - ranking = 13.396227789906keywords = physical examination, physical (Clic here for more details about this article) |
4/10. Urinary urgency and frequency: what should a clinician do?Obstetrician-gynecologists often care for women with urinary symptoms of urgency and frequency. These symptoms are bothersome and treatable. Although it is rare that serious disease is causative, the clinician must be alert to ominous signs and physical findings. Most patients experience relief of their symptoms after a simple initial evaluation with appropriately directed treatment. A step-wise evaluation includes the directed history and physical, assessment of urinary habits, typically with a urinary diary, and occasionally an assessment of voiding efficiency, typically with a postvoid residual. Treatments may include myofascial therapy when trigger points are present on physical examination. Behavioral therapy and pharmaceuticals also play an important role. Persistent symptoms, hematuria, severe de novo postoperative symptoms, and ominous physical findings may warrant specialty consultation.- - - - - - - - - - ranking = 9.6981138949529keywords = physical examination, physical (Clic here for more details about this article) |
5/10. Paraurethral leiomyoma in a female causing urinary obstruction.We report a case of paraurethral leiomyoma in a female patient, in which the first symptoms were dysuria and sensation of incomplete voiding. The physical examination revealed a mass in the anterior vaginal wall. The diagnosis was made through ultrasonography and pelvic MRI and confirmed by transvaginal ultrasound-guided needle biopsy. The surgical excision was accomplished without opening the urinary tract. A review of the relevant published studies and a suggestion for the appropriate management of these cases are included.- - - - - - - - - - ranking = 6.6981138949529keywords = physical examination, physical (Clic here for more details about this article) |
6/10. Appendiceal abscess masquerading as acute urinary retention in children.Two boys with acute urinary retention were found to have a persistent pelvic mass after bladder decompression. Evaluation in each disclosed a large pelvic abscess secondary to a ruptured appendix. The diagnosis of appendicitis may be difficult and appendiceal abscess presenting with acute urinary retention in children has been reported previously in only 7 instances. history, physical examination, laboratory studies, and radiographic and ultrasonic evaluations should lead to the correct diagnosis, and surgical intervention restores normal voiding.- - - - - - - - - - ranking = 6.6981138949529keywords = physical examination, physical (Clic here for more details about this article) |
7/10. Micturition syncope: an atypical case.A forty-nine-year-old man had episodes of micturition syncope associated with an asymptomatic urinary tract infection. Treatment of the infection resolved the syncopal episodes. Micturition syncope occurs in the standing position; physical, electrocardiographic, and electroencephalographic studies usually have normal results. The case reported here is atypical in that micturition syncope was the only apparent symptom of urinary tract infection.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/10. spinal cord and nerve root lesions in children presenting with urinary dysfunction.Three cases of bladder dysfunction as the first indication of tumors involving the spinal cord and sacral nerve roots are presented. The correct diagnosis was delayed in each instance. The relationship of such tumors to bladder dysfunction is discussed and the need for careful history and physical examination is stressed. It is emphasized that neurologic disease may present with urinary dysfunction. Neurological symptoms, physical findings and radiographic abnormalities of the spine should be noted.- - - - - - - - - - ranking = 7.6981138949529keywords = physical examination, physical (Clic here for more details about this article) |
9/10. Psychogenic urinary retention.The literature on psychogenic urinary retention is reviewed. 2 cases treated by analytical psychotherapy are reported, in which significant demand for physical punishment was revealed and seen as linked to unacceptable, unconscious sadistic and aggressive feelings. Some psychodynamic aspects of what is considered to be "a disturbance of internal body space' are discussed. Psychogenic urinary retention has received little attention in the literature. It may represent the uneasy position this disorder of bodily function occupies in clinical practice, with clear physical symptoms and associated psychological factors. The condition is more frequent in females, usually young adults. Case histories regularly record the placid, passive presentation of these patients, childhood enuresis and disturbed backgrounds. The diagnosis, "hysteric', is frequent and most psychodynamic evaluations suggest the symptom represents a displacement of unacceptable sexual wishes and impulse. 2 patients treated by analytical psychotherapy are reported who, whilst fulfilling many of the criteria already noted, additionally revealed an intense desire for physical punishment. This punitive demand had less to do with unacceptable sexual wishes, than guilt at repressed aggressive drives of considerable magnitude. The role of aggression in the genesis of psychogenic urinary retention has so far been little studied.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
10/10. Inguinal cystoceles: a previously overlooked etiology of prostatism in men without bladder outlet obstruction.PURPOSE: We determine whether inguinal cystoceles, a type of extraperitoneal herniation of the bladder, are responsible for symptoms consistent with prostatism in men without bladder outlet obstruction. MATERIALS AND methods: From January 1996 to February 1997 inguinal cystoceles were treated with surgical repair of the floor of the inguinal canal in 8 men with a relatively long history of symptoms consistent with prostatism. The diagnosis of inguinal cystoceles was based on the filling phase of video urodynamic studies done with the patient standing. The clinical outcome of surgery was assessed using the International prostate Symptom Score and urodynamic findings. RESULTS: All inguinal cystoceles studied were physically occult but clearly detected as wide-mouthed, mild protrusions of the bladder wall in the inguinal region on cystograms obtained with the patient standing. Although clear cystoceles were present on radiography on the right side in 1 case, the left side in 2 and bilaterally in 5, apparent bilateral weakness in Hesselbach's triangle was noted in all at surgery. High detrusor opening pressure and a relatively long opening time were regarded as urodynamic parameters characteristic of this condition. These parameters and subjective symptoms dramatically improved after bilateral surgical repair of the floor of the inguinal canal. CONCLUSIONS: Inguinal cystoceles negatively affect voiding dynamics by increasing opening pressure and opening time, indicating that they should be considered in the differential diagnosis of men with symptoms consistent with prostatism. Video urodynamics is mandatory to detect this condition, which to our knowledge has been previously overlooked on radiography and urodynamics.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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