Vesicoenteric fistula due to bladder squamous cell carcinoma.

Vesicoenteric fistula is a rare complication of bladder squamous cell carcinoma. We report the case of a 70-year-old male who complained of painless, total gross hematuria. Abdominopelvic computed tomography (CT) revealed an approximately 2.7-cm lobulated and contoured enhancing mass in the bladder dome. We performed partial cystectomy of the bladder dome after transurethral resection of the bladder. The biopsy result was bladder squamous cell carcinoma, with infiltrating serosa histopathologically, but the resection margin was free. Postoperatively, follow-up CT was done after 3 months. Follow-up CT revealed an approximately 4.7-cm×4.0-cm lobulated, contoured, and heterogeneous mass in the bladder dome. A vesicoenteric fistula was visible by cystography. Here we report this case of a vesicoenteric fistula due to bladder squamous cell carcinoma.

Fungal urinary tract infection in burn patients with long-term foley catheterization.

PURPOSE: It is well known that fungi become predominant microorganisms in the urine of patients with long-term Foley catheters. This study was conducted to evaluate the lengths of time for fungi to cause urinary tract infection (UTI) and to identify predictors of fungal UTI in burn patients with long-term Foley catheters. MATERIALS AND METHODS: A total of 93 patients who did not have infection at the time of admission but later had fugal UTI were evaluated. Urinalysis, urine culture, and Foley catheter indwelling were done at admission. All patients were administered prophylactic antibiotics from admission. Urine cultures were run every week, and catheters were changed every 2 weeks for each patient. RESULTS: Three of the 93 patients (3.2%) displayed fungal UTI at the 1st week of catheter indwelling. However, most patients (78.5%) displayed fungal UTI from 2nd to 5th week after catheter indwelling. The most prevalent fungus identified was Candida tropicalis (60.2%). By univariate logistic regression analysis, only the total body surface area burned (TBSAB) was predictive of fungal UTI in burn patients (p=0.010). By multivariate logistic regression analysis, underlying disease (p=0.032) and TBSAB (p=0.036) were predictors of fungal UTI. Patients with higher TBSAB were more likely to display shorter intervals from Foley catheterization to fungal UTI. CONCLUSIONS: Fungal UTI was initially found at the 1st week of urinary catheter indwelling, but the majority of cases occurred after the 1st week and appeared earlier in patients with underlying disease or higher TBSAB. Underlying disease and TBSAB were predictors of early fungal UTI.

Erectile dysfunction in patients with electrical injury.

OBJECTIVES: To estimate the prevalence of ED in electrical injury patients and correlate the results with the electric voltage and the pathway of electric current at the time of injury. METHODS: Mails and phone surveys had been undertaken to 416 electrical injury patients who had been admitted with electrical injury to our burn care center from November 1998 to December 2003. Patients were given a self-complete questionnaire, including international index of erectile function (IIEF-5). Also, we reviewed the voltage, the pathway of electric current and other disease history such as hypertension (HTN), diabetes mellitus (DM), and neurologic disease. Of 416 subjects, 276 agreed to participate. Of these 276 subjects, 20 were excluded for HTN, DM, and neurologic disease. RESULTS: Of the 256 patients, 52.7% had ED. There was no statistically significant difference among the age groups. Of the patients, 58.4% with high-voltage injury had ED, 21.2% low voltage, and 33.3% unknown voltage, which was statistically significant. The prevalence of ED, according to the pathway of electric current, was 100% when the whole body was affected, 70.2% upper-lower body, 44.4% lower-lower body, 31.9% upper-upper body, 15.4% electrical spark burn, and 22.2 % unknown. CONCLUSIONS: This is the first study of ED in electrical injury patients. High-voltage injures showed the higher prevalence of ED than low voltage. Whole and upper-lower body pathway of the electric current showed a higher prevalence of ED compared with focal/local involvement (electrical spark burn), lower-lower body, and upper-upper body.