Ön Vajinal Duvar Prolapsusunu Taklit Eden Subüretral Abse: Olgu Sunumu

Year 2023, Volume: 33 Issue: 6, 806 - 809, 31.12.2023

İrem Kurt , Alican Kaan Ünal , Mehmet Kulhan , Cetin Celik , İsmail Harmankaya

https://doi.org/10.54005/geneltip.1311478

Abstract

Giriş: Önceden sistosel olarak bilinen ön vajinal duvar prolapsusu (AVWP), ön vajinal duvar ve mesanenin herniasyonudur. Çok faktörlü bir patolojidir. AVWP'li hastalar, spesifik olmayan semptomlar olan pelvik baskı hissi ve vajinadan dışarı taşan bir şey, idrar kaçırma ve disparoni bildirebilir.
Olgu: Türk, 73 yaşında, evli, 20 yıldır menopozda olan G4P4 kadın hasta, iki haftadır dizüri ve idrar kaçırma ve 2 yıldır genital bölgede ele gelen kitle şikayeti ile polikliniğimize başvurdu. Vajinal muayenesinde vajen ve serviks normal görünüyordu ve sistosel poşunun altında distal üretradan mesane tabanına uzanan semimobil kitle ile birlikte grade 3 AVWP görüldü. Cerrahi eksizyon planı ile 3. derece AVWP teşhisi kondu. Üretra altında mesane duvarına kadar uzanan 4-5 cm boyutlarında bilobüler kistik kitle izlendi. Makroskopik incelemede 4,5 x 2,8 x 2 cm boyutlarında zaröz doku parçası, mikroskobik incelemede kazeifiye granülomatöz enflamasyon saptandı. Tüberküloz şüphesi ile enfeksiyon hastalıkları (ID) polikliniğine sevk edildi. PPD testi 0 mm idi. Aktif tüberküloz şikayeti yoktu. İdrar kaçırma şikayeti ile kliniğimize başvurdu. Vajinal muayenesinde mesane uyarımı ile istemsiz idrar kaçırdığı görüldü. Transvajinal bant (TVT) implantasyonunu planlandı.
Tartışma: Bu vakanın AVWP'nin ayırıcı tanısı hakkında fikir oluşturmasına yardımcı olacağını düşünüyoruz. Yanlış tanıya yol açmamak için AVWP tanısından emin olunmadan önce ön vajinal duvarın mesane ve üretraya yakınlığı nedeniyle olası diğer genitoüriner patolojiler ayırıcı tanıda yer almalıdır.

Keywords

ön vajinal duvar prolapsusu, subüretral abse, kazeifiye granülomatöz enflamasyon

A Suburethral Abscess Mimicking An Anterior Vaginal Wall Prolapse: A Case Report

Abstract

Introduction: Anterior vaginal wall prolapse (AVWP), previously known as cystocele, is a herniation of the anterior vaginal wall and the bladder. It is a multifactorial pathology. Patients with AVWP may report a feeling of pelvic pressure and something bulging out of the vagina, urinary incontinence, and dyspareunia which are nonspecific symptoms.
Case: A 73-year-old married Turkish G4P4 female who has been menopausal for 20 years, presented to the outpatient clinic with dysuria and urinary incontinence lasting for two weeks, and a palpable mass located in the genital area for 2 years. On her vaginal examination, the vagina and cervix appeared normal, and a grade 3 AVWP along with a semi-mobile mass extending from the distal urethra to the bladder base under the cystocele pouch was observed. She was diagnosed with a grade 3 AVWP with a plan for the surgical excision. A bilobular cystic mass was observed under the urethra, extending to the bladder wall with a size of 4-5 cm. The macroscopic examination showed a membraneous tissue piece of 4.5 x 2.8 x 2 cm, and the microscopic examination revealed a caseified granulomatous inflammation. Upon the suspicion of tuberculosis, we referred her to the infectious diseases (ID) clinic. Her PPD test was 0 mm. She had no complaints of active tuberculosis. She presented to our clinic with urinary incontinence. On her vaginal examination, involuntary leakage of urine with bladder stimulation was observed. We planned the implantation of transvaginal tape (TVT).
Discussion: We believe that this case will help establish an idea about the differential diagnosis of AVWP. The differential diagnosis should include the other possible genitourinary pathologies due to the close proximity of the anterior vaginal wall to the bladder and the urethra before ensuring the diagnosis of the AVWP in order not to misdiagnose.

Keywords

anterior vaginal wall prolapse, suburethral abscess, caseified granulomatous inflammation

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