MRI Features of Presumed Primary Extranodal Lymphoma of the Bulbospongiosus Muscle Causing Stranguria

ABSTRACT Hematopoietic neoplasia is common in dogs, with canine non-Hodgkin lymphomas representing more than 80% of all hematopoietic cancer. However, extranodal infiltration of the skeletal muscle by non-Hodgkin lymphoma is rare in humans and dogs. A 9 yr old neutered male English mastiff presented with a 3 wk history of recurrent stranguria, pelvic limb ataxia, and mild proprioceptive deficits bilaterally, worse in the right pelvic limb. MRI showed an expansile ill-defined lesion within the bulbospongiosus muscle. The lesion had intermediate signal intensity to muscle and fat on T2-weighted imaging and was isointense to unaffected muscle on precontrast T1-weighted imaging. Contrast enhancement was heterogeneous and there was digitate signal alteration within adjacent perilesional fat. Ultrasound examination confirmed a hypoechoic lesion infiltrating the muscle. Cytological examination yielded a diagnosis of high-grade lymphoma. This report provides the first description of MRI findings associated with cytologically confirmed lymphoma of the skeletal muscle in the dog. Although nonspecific, the imaging features strongly correlate with those in the medical literature and lymphoma should be considered a pertinent differential in cases presenting with similar imaging findings.

Adjustable bulbourethral male sling: Experience after 30 cases of moderate to severe male stress urinary incontinence

Objective: To report our experience using the Argus perineal sling from July 2015 to April 2018 for male stress urinary incontinence (SUI) after prostatic surgery. To evaluate the safety, efficacy and healthrelated quality of life in patients undergoing this procedure. Patients and methods: The positioning of an adjustable bulbourethral male sling provides a perineal incision, exposure of the bulbospongiosus muscle and the application of the sling bearing on it with transobturator passage of the two extremities with out-in technique. To modulate the bearing tension on the urethra, with a rigid cystoscope the Retrogade Leak Point Pressure is measured, increasing it by 10-15 cm of H20 from baseline. We retrospectively evaluated the results of this implant performed by the same operator on 30 patients who presented post-operative SUI from medium to severe (> = 2 pads/day, pad test at one hour > = 11 g). Mean operative time and possible intra and postoperative complications were evaluated. Postoperatively each patient was reassessed according to the following parameters: number of pads consumed/ die, pad tesy at one hour, ICQS-F, any related side effects. Results: After the intervention, 21 of 30 patients (70% of the total) were totally continent (< 1 pad / day, pad test at 1 h < 1-2 g, ICQS-F < 11), out of them 4 required a single adjustment at 3 months in order to achieve this result. 9 of 30 patients (30 %) achieved a clinically significant improvement without obtaining total continence (mean reduction of the n° pads/day: -2.5 ± 1 DS; average reduction of the pad test at 1 h: -20 g ± 4 DS; ICQS-F average reduction: -6 points ± 2 DS), out of them 5 required a 3 month adjustment to obtain these improvements resulting, 4 needed 2 adjustments resulting because the first adjustment was not satisfactory and one who ameliorated from severe to moderate incontinence decided to live in this clinical condition. Conclusions: The results of our study show that the positioning of this sling represents a valid treatment for the moderate and severe post-surgical male SUI. The possibility of adjusting the tension of the sleeve in a "second look" makes the intervention adaptable according to the results obtained. Only multicentric clinical trials on larger series would clarify and eventually confirm the clinical benefits of this sling in post-surgical male SUI.