Publication: "Voiding" sistoüretrografide nadir görülen bir bulgu: Prostatik reflü
Abstract
Amaç: "Voiding" sistoüretrografide prostat bezinin opasifikasyonu ender olarak görülen bir durumdur. Özellikle eşlikli distal üretral obstrüksiyon varlığında, mesane boynundaki yetersizlik sonucu görülen bu durum yüksek intralüminal basıncın prostatik üretraya doğrudan iletiminin bir sonucudur. Bu çalışmada 27 yaşındaki nörojenik mesaneli erkek olguda prostatik reflü bulguları gösterilerek literatür bilgileri eşliğinde patofizyolojisi, klinik anlamı ve prognostik değeri tartışılmıştır. Gereç ve Yöntem: Çocukluğundan itibaren sık tekrarlayan üriner sistem enfeksiyonu geçiren ve enürezis şikayeti olan 27 yaşındaki erkek hastaya "voiding" sistoüret-rografi incelemesi (VSUG) yapıldı. Ayrıca üriner sistem ult-rasonografi ve lumbosakral manyetik rezonans görüntüleme (MRG) gerçekleştirildi. Bulgular: VSUG incelemesinde mesane duvarında yaygın trabekülasyon ve psödodivertikül gelişimleri saptandı. Mesanede elongasyon ve kapasitesinde azalma mevcuttu. VSUG'de mesanenin dolma fazında prostat bezinin santral ve periferik loblarının opaklaştığı izlendi. Vezikoüretral reflü saptanmadı. Üriner sistem ultrasonog-rafisinde bilateral grade 2 hidroüreteronefroz, lumbosakral MRG'de ise "tethered cord" saptandı. Sonuç: VCUG incelemelerinde bu radyolojik bulgunun araştırılması oldukça önemlidir. Çünkü bu bulgu üriner sistemin miksiyon sırasında yüksek basınca maruz kaldığının göstergesidir.
Aim: The visualization of the prostatic gland during voiding cystourethrography is very rare. Such reflux is se­en as a sequel to the bladder neck incompetence in the presence of coexisting distal urethral obstruction resul­ting in direct transmission of high intralüminal pressures to the prostatic urethra. In this case report, we discuss the clinical impact, pathophysiology and prognostic value of prostatic reflux in a 27-year-old male patient. Materials and Methods: A 27-year-old man presented to our hospital with urinary symptoms of frequent urinary tract infections, urgency and enuresis. Urinary system ult-rasonography, voiding cystourethrography (VCUG) and lumbosacral magnetic resonance imaging were performed. Results: In VCUG, there were trabeculation and pse-udodiverticules in the bladder. Bladder capacity was dec­reased and it was elongated. During VCUG,. contrast ma­terial was seen to reflux into the central and peripheral lo­bes of the prostatic gland opacifying them. There was no vesicourethral reflux. In the urinary system ultrasonog-raphy, there was grade 2 hydrouretheronephrosis bilate­rally. In the lumbosacral MRG, tethered cord was detected. Conclusion: In VCUG, to search for this radiologic fin­ding is very important because it indicates the exposure to high intralüminal pressures of urinary tract during mic-turation.
Aim: The visualization of the prostatic gland during voiding cystourethrography is very rare. Such reflux is se­en as a sequel to the bladder neck incompetence in the presence of coexisting distal urethral obstruction resul­ting in direct transmission of high intralüminal pressures to the prostatic urethra. In this case report, we discuss the clinical impact, pathophysiology and prognostic value of prostatic reflux in a 27-year-old male patient. Materials and Methods: A 27-year-old man presented to our hospital with urinary symptoms of frequent urinary tract infections, urgency and enuresis. Urinary system ult-rasonography, voiding cystourethrography (VCUG) and lumbosacral magnetic resonance imaging were performed. Results: In VCUG, there were trabeculation and pse-udodiverticules in the bladder. Bladder capacity was dec­reased and it was elongated. During VCUG,. contrast ma­terial was seen to reflux into the central and peripheral lo­bes of the prostatic gland opacifying them. There was no vesicourethral reflux. In the urinary system ultrasonog-raphy, there was grade 2 hydrouretheronephrosis bilate­rally. In the lumbosacral MRG, tethered cord was detected. Conclusion: In VCUG, to search for this radiologic fin­ding is very important because it indicates the exposure to high intralüminal pressures of urinary tract during mic-turation.