This 30-year-old black male was born with a meningoceleA meningocele is the herniation of the CSF-filled meningeal sac through a vertebral defect. which was repaired in childhood. Despite repair of the meningoceleA meningocele is the herniation of the CSF-filled meningeal sac through a vertebral defect., this patient continued to have a neurogenic bladderNeurogenic bladder is a dysfunction of the bladder caused by a nervous system lesion..
Six months previous to this admission, the patient passed a single renal calculusA renal calculus is a "kidney stone." but intravenous pyelogramThe patient is given an intravenous injection of contrast medium that rapidly enters the urine. Radiographs are then taken to show the passage of the contrast-containing urine through the pelvicaliceal system. (IVP) showed left nephrolithiasisNephrolithiasis is the presence of a urinary calculus within the kidney. (a 1 cm stone in the lower lobe). For 6 months the patient had to be catheterized each day for 6 hours. However, he continued to complain of hesitancyHesitancy is the inability to begin the stream of urine. and urgencyUrgency is the experience of an intense and immediate desire to void. and suffered occasional urinary tract infections.
On this admission, a culture of the patient's urine specimen grew Gram-negative bacilli (Proteus species). CystoscopyCystoscopy is the direct visual examination of the bladder via a cystoscope. showed heavy trabeculation of the bladder with early diverticulaA bladder diverticulum is an out-pouching of the bladder wall, usually caused by chronic urethral obstruction. and the left ureteral orifice showed squamous metaplasia. The lower pole of the left kidney was removed surgically, following which the patient recovered and was discharged on antibiotics.
This is a low-power photomicrograph showing the full cortical and medullary thickness of the kidney. Note that there is a dilated calyx containing some red blood cells in the center of the section (arrow). The cortex is markedly thin and has severe lesions of degeneration and atrophy, although these are hard to appreciate at this low magnification.
This high-power photomicrograph demonstrates the transitional epithelium lining the renal calyx (1) and the junction (transition zone) to a thicker hyperplastic epithelium (2). Note the inflammatory cells and increased vascular response in the stromal tissue (3) lying beneath the normal transitional epithelium.
In areas adjacent to the normal transitional epithelium, there are areas of epithelium (arrows) where the epithelial cells have the character of normal squamous epithelium as found in the dermis. However, squamous epithelium is not normal in the renal pelvis. This adaptive change is referred to as squamous metaplasia.
A neurogenic bladderNeurogenic bladder is a dysfunction of the bladder caused by a nervous system lesion. is any condition or dysfunction of the urinary bladder caused by a lesion of the central or peripheral nervous system. Complications primarily include stasis, infection, and stone formation.
Stasis and infection.
- eMedicine Medical Library: Nephrolithiasis
- eMedicine Medical Library: Neurogenic Bladder
- Merck Manual: Urinary Calculi
- Merck Manual: Neurogenic Bladder
- Merck Manual: Approach to the Genitourinary Patient
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