Novel evaluation of nephrolithiasis as a complication of gout: a cross-sectional study using helical computerized tomography.

PURPOSE: We clarified whether the clinical profiles of patients with a history of urolithiasis (stone formers) truly reflect those of patients who currently have renal stones (stone carriers). MATERIALS AND METHODS: We evaluated 463 patients with gout using helical computerized tomography, urolithiasis history and relevant clinical parameters. RESULTS: Nephrolithiasis was observed in 157 of the 463 patients (34%) on helical computerized tomography but only 75 (16%) had a urolithiasis history. Of the 157 stone carriers 107 (68%) did not have a urolithiasis history. In those 157 patients serum urate and serum creatinine were higher than in the 306 nonstone carriers (p = 0.017), and the estimated glomerular filtration rate and urinary pH were lower (p = 0.0096 and 0.0249, respectively). However, there was no significant difference in laboratory findings between the 75 stone formers and 388 nonstone formers. Serum urate and creatinine were higher, and the estimated glomerular filtration rate and urine pH in bilateral stone carriers were lower than in unilateral stone carriers. According to HU density attenuation values on computerized tomography, an estimated third of the calculi that complicated 31 recent gout cases was uric acid. CONCLUSIONS: The concept of stone formers may lead to underestimating the prevalence of urolithiasis. Our analysis of stone carriers showed that a higher stone burden is associated with greater renal derangement, as determined by serum urate and creatinine, the estimated glomerular filtration rate and urine pH. To accurately clarify the correlation of gout and urolithiasis, it is advantageous to select stone carriers as subjects of study.

Giant hydronephrosis with increased carbohydrate antigen 19-9 both in serum and fluid.

We report a case of right giant hydronephrosis. A 68-year-old man was admitted to our hospital with chief complaints of general fatigue, loss of appetite and a one-year history of progressive fullness on whole abdomen. Abdominal computed tomography scan exhibited a huge, homogeneous, low density mass originating from the right kidney. We performed right percutaneous nephrostomy and drained over 6,500 ml bloody fluid. Cytological examination of the drained fluid revealed atypical nuclear appearance defined as class III. Increased values of carbohydrate antigen 19-9 were observed both in the fluid as well as in the serum. We performed right nephrectomy. Macroscopic appearance of the resected kidney showed marked stenosis at the portion of ureteropelvic junction. Histological analysis of the stenotic portion demonstrated marked fibrosis without findings of malignancy.

Surgical correction of buried penis after traffic accident - a case report.

BACKGROUND: Buried penis, most commonly seen in children, is particularly debilitating in adults, resulting in inability to void while standing and it also affects vaginal penetration. We report a case of buried penis due to a traffic accident, which caused dislocation of the fractured pubic bone that shifted inside and pulled the penis by its suspensory ligament. CASE PRESENTATION: A 55-year-old man was admitted to our hospital with a chief complaint of hidden penis while in the sitting position. He had suffered a pelvic fracture in a traffic accident four years previously, and his penis was covered with suprapubic fat when he was in a sitting position. He was unable to have sexual intercourse. We performed a penile lengthening procedure, including inverse V-Y-plasty of the dorsal skin of the penile root, suspensory desmotomy and fat removal, under general anesthesia. There was a good cosmetic result with satisfactory penile erection, which allowed successful sexual intercourse after surgery. CONCLUSION: We performed penile elongation surgery with inverse V-Y-plasty of the dorsal skin of the penile root, suspensory desmotomy, and fat removal. Surgical treatment of buried penis achieves marked aesthetic and functional improvement, and benefits the majority of patients, resulting in satisfactory erection and successful sexual intercourse.