Pelvic actinomycosis: urologic perspective

Marella, Venkata K.; Hakimian, Omid; Wise, Gilbert J.; Silver, David

doi:10.1590/s1677-55382004000500002

Cited by 30 publications

(29 citation statements)

References 34 publications

(30 reference statements)

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“…After surgery, the patient should receive 1-2 million units of penicillin, continuing for 12-18 months. If the diagnosis is made at the time of surgery, treatment consists of 10-20 million units of intravenous penicillin, followed by a long-term oral penicillin therapy [14] . Urological procedures are necessary to differentiate actinomycosis from invasive bladder cancer or benign tumours, and the diagnosis is made pathologically [15,16] .…”

Section: Discussionmentioning

confidence: 99%

Intrauterine Device-Associated Actinomycosis of the Ovary and Urinary Bladder: A Case Report

Bottai

Marzi²,

Alessandrini³

et al. 2010

Urol Int

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Actinomycosis of the urinary bladder is rare, mostly subsequent to abdomino-pelvic infection, and usually affects women with long-term use of an intrauterine device. We describe a case of vesical actinomycosis mimicking a papillary bladder tumour in a 56-year-old woman with primary manifestation of the disease in the genital tract, subjected to two transurethral resections after relapse of a polypoid mass in the bladder. Urological procedures are necessary to differentiate actinomycosis from bladder cancer and the diagnosis is often made histologically.

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Section: Discussionmentioning

confidence: 99%

Intrauterine Device-Associated Actinomycosis of the Ovary and Urinary Bladder: A Case Report

Bottai

Marzi²,

Alessandrini³

et al. 2010

Urol Int

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“…These can be accompanied by constitutional symptoms and mass-effect, such as obstruction or visceral pressure sensation. 7,8 Due to non-specific symptom profiles, clinical diagnosis of actinomycosis is made with difficulty.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Sulfur granules are often seen in biopsy specimens, but may also be detected in urine cytology as an initial clue to the etiology. 7,9 Microscopic analysis of tissue should demonstrate Gram positive bacilli with the appearance of filaments and hypea. Inflammatory tissue change should also be present.…”

Section: Diagnosismentioning

confidence: 99%

“…10 These treatments tend to be carried out in patients where transurethral resection was not attempted based on the cystoscopic and radiologic morphology. 3,7 Chronic antibiotic treatment of actinomycosis with penicillin as the drug of choice is the prevailing recommendation, 1,6 especially when diagnosis is made preoperatively from TURBT pathology reports. Starting doses should be between 10 and 20 million units intravenously for 4 to 6 weeks.…”

Section: Treatmentmentioning

confidence: 99%

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Actinomycosis of the urinary bladder

Huang

Al-Essawi

2013

CUAJ

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Actinomycosis of the urinary bladder is a rare anaerobic bacterial infection caused by Actinomyces isrealii. Initial diagnosis is often difficult and this disease is easily misdiagnosed as a urothelial or urachal tumour. The definitive diagnosis is usually made postoperatively via tissue pathology. We discuss a case of a 54-year-old male with a smoking history and a 2.5-week history of gross hematuria. Ultrasound, computed tomography and cystoscopy revealed a large inflammatory mass adherent to the right, anterior bladder wall, suggesting malignancy. Transurethral resection and histological pathology subsequently confirmed inflammatory urothelium and gram-positive bacteria consistent with actinomyces species. IntroductionActinomycosis of the urinary bladder is a rare infection caused by the anaerobic bacteria Actinomyces isrealii. Initial diagnosis is often difficult, as it mimics urothelial or urachal tumours.1,2 The definitive diagnosis is usually made postoperatively via tissue pathology. We report a case of primary bladder actinomycosis initially diagnosed as a urothelial carcinoma that subsequently underwent a transurethral resection of a bladder tumour (TURBT). Pathologic examination subsequently confirmed actinomycosis. Case reportA 54-year-old male presented with symptoms of 2.5 weeks of painless, gross hematuria, frequency, nocturia and hesitancy. He denied any history of irritative voiding symptoms. He has a medical history of diabetes, dyslipidemia, erectile dysfunction and a 10-pack/year smoking history. On physical exam, he had a benign abdominal and rectal exam.Follow-up ultrasound by the family physician revealed a 7.7 × 5.7 × 7.3 cm mass extending from the right bladder wall with vascularity on colour Doppler and possible extension through the bladder wall (Fig. 1). Cystoscopy showed a large bladder tumour involving the posterior wall. Urothelial carcinoma and urachal tumours were suspected at this time. The urine cytology was negative for malignant cells. A transurethral resection of the mass showed a high-grade invasive lesion macroscopically, but tissue diagnosis returned inflamed urothelial mucosa with colonies of gram positive bacteria morphologically consistent with actinomyces species (Fig. 2).Based on the pathology report, a computed tomography (CT) scan was ordered to assess for the extent of infection, inflammation and lymph node involvement. Imaging showed extensive inflammatory thickening of the bladder wall and broad-based mass on the right, anterior wall with perivesical fat involvement tracking in a cephalad direction (Fig. 3).Treatment with high-dose amoxicillin was carried out for 3 months. Follow-up CT and cystoscopy post-treatment showed residual mild inflammation and edema on the right posterior bladder wall with vast improvement over previous investigations (Fig. 4). Another 3-month regimen of amoxicillin was prescribed with instructions for follow-up imaging. Discussion PathophysiologyActinomycosis is a chronic infectious disease with widespread anatomical distributi...

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“…Also, it was recorded as a late sequel of orthopedic procedures, acetabulum in particular [7,8]. Vesico-cutaneous fistula was reported in a case of chronic pelvic actinomycosis [9], which is a hard inflammatory mass caused by specific bacterial infection. On the other hand, vesicococcygeal fistula developed in a case of bladder malakoplakia, which is another rare inflammatory lesion affecting the bladder endothelial.…”

Section: Commentsmentioning

confidence: 99%