POSTOPERATIVE
NEPHROGENIC
ADENOMA OF BLADDER SAMUEL
A. LEONARD,
ARTHUR J. SILVERMAN, JAMES
W. LANGSTON,
HAROLD A. FUSELIER,
M.D. M.D. M.D. JR., M.D.
From the Department of Urology, Touro Infirmary, New Orleans, Louisiana
ABSTRACT - Nephrogenic adenomu of the bladder-, which has been associated with either a chronic infection or severe trauma to the bladder, occurred in a six-year-old girl apparently secondary to urologic surgery. It was also a possible cause of enuresis.
Kaany and Werner’ recently reviewed nephrogenic adenoma of the bladder. These authors and others2-‘0 have stressed the association of nephrogenic adenoma of the bladder with severe trauma and previous infection. We report a case which occurred after a urologic procedure. Infection or another form of trauma was not present. Case Report In September, 1970, a three-year-old white girl was first seen and evaluated for enuresis. There was no history of urinary tract infection. The urine was chemically and microscopically normal and sterile on culture. Excretory urography revealed normal upper urinary tracts. The urethra calibrated less than 12 French, and a cystogram demonstrated bilateral ureteral reflux without dilatation of the upper urinary tracts. Minimal trabeculation was seen at cystoscopy. The urethra was dilated and antimicrobial therapy was begun. There was no symptomatic improvement, and six months after the first evaluation, the child’s symptoms worsened. She was readmitted to the hospital for evaluation. The urethra and bladder neck were found to be widely patent, but reflux Presented at the Annual Meeting of the Southeastern Section, American Urological Association, Inc., Atlanta, Georgia, April 13, 1975.
UROLOGY
/ MARCH
1976 / VOLUME
VII,
NUMBER 3
was still present and there was early dilatation of the urinary tracts. Because of these findings, a bilateral ureteral reimplantation was performed in March, 1971. The patient had an uncomplicated postoperative course and almost immediately reverted to a normal voiding pattern. The child remained asymptomatic and clinically well until August, 1974, when she was again seen for the sudden reappearance of enuresis. Again, the urine was chemically and microscopically normal and a urine culture sterile. Repeat evaluation revealed normal upper urinary tracts and complete emptying of the bladder on excretory urography. Voiding cystourethrogram was normal and no filling defects were visualized in the bladder. The patient was treated with imipramine hydrochloride (Tofranil) 25 mg. at bedtime, with no improvement in the symptoms. The patient was readmitted to the hospital and cystoscopy demonstrated a small papillary lesion on the posterior wall of the bladder which appeared grossly to be a papillary transitional cell carcinoma. Biopsy was taken and the base of the lesion fulgurated. The excised lesion was microscopically typical of nephrogenic adenoma of the bladder. After excision of the lesion, the enuresis ceased. Postoperatively, the patient has remained clinically well and continues to have a sterile urine.
327
Comment The consensus of previous authors’-lo regarding nephrogenic adenoma of bladder is that.previous trauma and infection play a role in the development of this lesion. This case, we believe, represents the first reported instance of “surgical trauma” being the apparent precipitating cause. Ochsner Clinic 1514 Jefferson Highway
New Orleans, Louisiana 70121 (DR. FUSELIER) References Nephrogenic 1. KAANY, E., and WERNER, S. L.: adenoma of bladder, Urology 4: 343 (1974). 2. COLBY, F. H.: Embryonic rests of urinary bladder, Surg. Gynecol. Obstet. 40: 528 (1925).
328
3. DOW, J. A., and YOUNG, J. D., JR.: Mesonephric adenocarcinoma ofthe bladder, J. Urol. 100: 466 (1968). 4. FRIEDMAN,N. B., and KUHLENBACK,H.: Adenomatoid tumors of the bladder reproducing renal structures (nephrogenic adenomas), ibid. 64: 657 (1959). 5. FRIEDMAN,N. B., and ASH, J. E.: Tumors of the urinary bladder, in Atlas of Tumor Pathology, Washington, D. C., Armed Forces Institute of Pathology, 1959, section 8, part 31A. DAVIS, T. A.: Hamartoma of the urinary bladder, Northwest Med. 48: 182 (1949). MOSTOFI, F. K.: Potentialities of bladder epithelium, J. Urol. 71: 705 (1954). HANSEN,H. B.: Nephrogenic adenoma ofthe bladder, ibid. 88: 629 (1962). GOLDMAN, R. L.: Nephrogenic metaplasia (nephrogenic adenoma, adenomatoid tumor) of the bladder, ibid. 108: 565 (1972). 10. ALLAN, E.: Nephrogenic adenoma of the bladder, ibid. 113: 35 (1975).
UROLOGY /
MARCH 1976 /
VOLUME VII, NUMBER 3
NEPHROGENIC
ADENOMA OF BLADDER SAMUEL
A. LEONARD,
ARTHUR J. SILVERMAN, JAMES
W. LANGSTON,
HAROLD A. FUSELIER,
M.D. M.D. M.D. JR., M.D.
From the Department of Urology, Touro Infirmary, New Orleans, Louisiana
ABSTRACT - Nephrogenic adenomu of the bladder-, which has been associated with either a chronic infection or severe trauma to the bladder, occurred in a six-year-old girl apparently secondary to urologic surgery. It was also a possible cause of enuresis.
Kaany and Werner’ recently reviewed nephrogenic adenoma of the bladder. These authors and others2-‘0 have stressed the association of nephrogenic adenoma of the bladder with severe trauma and previous infection. We report a case which occurred after a urologic procedure. Infection or another form of trauma was not present. Case Report In September, 1970, a three-year-old white girl was first seen and evaluated for enuresis. There was no history of urinary tract infection. The urine was chemically and microscopically normal and sterile on culture. Excretory urography revealed normal upper urinary tracts. The urethra calibrated less than 12 French, and a cystogram demonstrated bilateral ureteral reflux without dilatation of the upper urinary tracts. Minimal trabeculation was seen at cystoscopy. The urethra was dilated and antimicrobial therapy was begun. There was no symptomatic improvement, and six months after the first evaluation, the child’s symptoms worsened. She was readmitted to the hospital for evaluation. The urethra and bladder neck were found to be widely patent, but reflux Presented at the Annual Meeting of the Southeastern Section, American Urological Association, Inc., Atlanta, Georgia, April 13, 1975.
UROLOGY
/ MARCH
1976 / VOLUME
VII,
NUMBER 3
was still present and there was early dilatation of the urinary tracts. Because of these findings, a bilateral ureteral reimplantation was performed in March, 1971. The patient had an uncomplicated postoperative course and almost immediately reverted to a normal voiding pattern. The child remained asymptomatic and clinically well until August, 1974, when she was again seen for the sudden reappearance of enuresis. Again, the urine was chemically and microscopically normal and a urine culture sterile. Repeat evaluation revealed normal upper urinary tracts and complete emptying of the bladder on excretory urography. Voiding cystourethrogram was normal and no filling defects were visualized in the bladder. The patient was treated with imipramine hydrochloride (Tofranil) 25 mg. at bedtime, with no improvement in the symptoms. The patient was readmitted to the hospital and cystoscopy demonstrated a small papillary lesion on the posterior wall of the bladder which appeared grossly to be a papillary transitional cell carcinoma. Biopsy was taken and the base of the lesion fulgurated. The excised lesion was microscopically typical of nephrogenic adenoma of the bladder. After excision of the lesion, the enuresis ceased. Postoperatively, the patient has remained clinically well and continues to have a sterile urine.
327
Comment The consensus of previous authors’-lo regarding nephrogenic adenoma of bladder is that.previous trauma and infection play a role in the development of this lesion. This case, we believe, represents the first reported instance of “surgical trauma” being the apparent precipitating cause. Ochsner Clinic 1514 Jefferson Highway
New Orleans, Louisiana 70121 (DR. FUSELIER) References Nephrogenic 1. KAANY, E., and WERNER, S. L.: adenoma of bladder, Urology 4: 343 (1974). 2. COLBY, F. H.: Embryonic rests of urinary bladder, Surg. Gynecol. Obstet. 40: 528 (1925).
328
3. DOW, J. A., and YOUNG, J. D., JR.: Mesonephric adenocarcinoma ofthe bladder, J. Urol. 100: 466 (1968). 4. FRIEDMAN,N. B., and KUHLENBACK,H.: Adenomatoid tumors of the bladder reproducing renal structures (nephrogenic adenomas), ibid. 64: 657 (1959). 5. FRIEDMAN,N. B., and ASH, J. E.: Tumors of the urinary bladder, in Atlas of Tumor Pathology, Washington, D. C., Armed Forces Institute of Pathology, 1959, section 8, part 31A. DAVIS, T. A.: Hamartoma of the urinary bladder, Northwest Med. 48: 182 (1949). MOSTOFI, F. K.: Potentialities of bladder epithelium, J. Urol. 71: 705 (1954). HANSEN,H. B.: Nephrogenic adenoma ofthe bladder, ibid. 88: 629 (1962). GOLDMAN, R. L.: Nephrogenic metaplasia (nephrogenic adenoma, adenomatoid tumor) of the bladder, ibid. 108: 565 (1972). 10. ALLAN, E.: Nephrogenic adenoma of the bladder, ibid. 113: 35 (1975).
UROLOGY /
MARCH 1976 /
VOLUME VII, NUMBER 3
