Urethraldivertikel als Ursache chronischer urogenitaler Schmerzen: Ein Fallbericht

Eine 53-jährige Patientin mit seit 20 Jahren persistierenden unerträglichen Schmerzen im Unterleib, vor allem bei Miktion und Defäkation, wurde in unserer urogynäkologischen Sprechstunde gesehen. Die Erhebung der Lebensqualität mittels King's Health Questionnaire zeigte eine massive Einschränkung. Klinisch war die distale Urethra extrem druckdolent und geschwollen. Die Perinealsonographie und die Magnetresonanztomographie zeigten ein ausgedehntes Gangsystem mit zystischen Strukturen sub- und paraurethral beidseits. Nach gezielter Suche entdeckte man 12 mm proximal des Meatus externus eine kleine Fistelöffnung. Intraoperativ fand sich ein Fistelgangsystem mit vorwiegend retrosymphysärer Höhlenbildung, welches über einen transvaginalen Zugang exzidiert wurde. Die Patientin ist 12 Monate postoperativ bis auf eine leichte Algurie beschwerdefrei und wünscht keine weitere Therapie. A 53-year-old woman suffering for 20 years from chronic genitourinary pain was seen in our urogynecological unit. Quality of life assessment by King's Health Questionnaire showed a highly negative impact on quality of life. Clinical examination revealed a painful and swollen distal urethra, and a small fistula was seen located 12 mm proximal to the meatus externus. Perineal ultrasound and magnetic resonance imaging showed multiple cystic formations bilaterally located in the suburethral and paraurethral regions. A diverticulectomy was performed using the vaginal approach. Twelve months after surgery the woman is completely satisfied and only complaining about slight alguria

Aliskiren – a promising strategy for ovarian ischemia/reperfusion injury protection in rats via RAAS

The aim of this study was to evaluate the effects of aliskiren, direct renin inhibitor, as an antioxidant and tissue protective agent and evaluate the molecular, biochemical, and histopathological changes in experimental ischemia and ischemia/reperfusion injury in rat ovaries. Forty-eight female rats were randomly divided into eight groups: in Group 1, only sham operation was performed. Group 2 received 100 mg/kg aliskiren and sham operated. In Group 3, 3 h-period of bilateral ovarian ischemia was applied. Group 4 received a 3-h period of ischemia followed by 3 h of reperfusion. Groups 5 and 6 received 50 and 100 mg/kg, respectively, of aliskiren and bilateral ovarian ischemia was applied (after a 3-h period of ischemia, both ovaries were surgically removed). To Groups 7 and 8, 50 and 100 mg/kg of aliskiren were administered, respectively, and the induction of ischemia was performed. At the end of a 3-h period of ischemia, bilateral vascular clips were removed, and 3 h of reperfusion continued. After the experiments, IL-1 beta, IL-6, TNF-alpha, and iNOS mRNA expressions and SOD, GSH, MDA, renin, and angiotensin-II levels were determined and histopathological changes were examined in rat ovaries. Aliskiren treatment normalized excessive changes in cytokine and oxidative stress markers in both ischemia and ischemia/reperfusion injury. Histopathologically, treatment with aliskiren ameliorated the development of ischemia and/or ischemia/reperfusion tissue injury. This study concluded that aliskiren treatment is effective in reversing ischemia and/or ischemia/reperfusion induced ovary damage via the improvement of oxidative stress, reduction of inflammation, and suppression of the renin-angiotensin aldosterone system