[A Case of Intravesical Foreign Body by Erosion of Surgical Mesh Used for an Inguinal Hernia Repair].

We report our experience with a case in which eroded mesh used for inguinal hernia repair migrated into the bladder. An 84-year-old man underwent surgery for colorectal cancer at the age of 40, and radical surgery for a right inguinal hernia at the age of 83. At his initial visit, he reported macroscopic hematuria. Cystoscopy revealed a yellowish-brown foreign body on the right bladder wall, and computed tomography showed the presence of emphysema in association with the foreign body. Based on a presumptive diagnosis of vesical calculi, transurethral lithotripsy was performed. However, the foreign body was strongly adherent to the bladder wall ; when lithotripsy was attempted, the calcified surface of the foreign body detached, and the exposed surface showed a mesh-like structure. Transurethral extraction was judged impossible ; therefore, laparotomy was performed at a later date to remove the foreign body, with en bloc resection including some of the bladder. The foreign body consisted of a surgical mesh that had been used for inguinal hernia repair. With the spread of surgery using surgical mesh, we should be careful about complications.

[A case of testicular tumor presenting with acute scrotum].

A 37-year-old man visited our hospital with a chief complaint of sudden onset of right scrotal pain. Because spermatic cord torsion was suspected, an exploratory incision was made. There was no spermatic cord torsion, but an induration was palpated in a part of the right testis. Because a testicular tumor was strongly suspected, right high orchiectomy was performed. The histopathological diagnosis was a pT1 seminoma. Our experience with this case suggests that testicular tumor should be considered in the differential diagnoses of acute scrotum.

[Chronic urinary retention in women caused by primary bladder neck obstruction : report of two cases treated successfully with transurethral resection of bladder neck].

A 60-year-old female was referred to our hospital for the treatment of chronic urinary retention which had compelled her to continue clean intermittent self catheterization (CIC) for several years. After further examination including physical examinations, urodynamic study, cystography, and urethrocystoscopy, she was diagnosed with primary bladder neck obstruction (PBNO). Transurethral resection of the bladder neck (TURBN) was performed to relieve the bladder outlet obstruction and she was free from CIC thereafter. Another 61-year-old female on CIC was also referred to our hospital and diagnosed with PBNO through detailed examinations including urodynamics. She was also successfully relieved of CIC after TURBN. Primary bladder neck obstruction is a condition which can be effectively treated by a less-invasive procedure when properly diagnosed by urodynamic examination. Urologists must keep this rare condition in mind as a possible cause of chronic urinary retention in women.

[A case of domestic violence-related Page kidney].

Page kidney is caused by the accumulation of blood in the perinephric or subcapsular space, resulting in compression of the involved kidney, renal ischemia and high renin hypertension. We describe a case of domestic violence-related Page kidney. This report also reviews previously described cases of Page kidney.

[Choriocarcinoma presenting as a spontaneous rupture of an adrenal metastasis: a case report].

A 20-year-old woman, who had a history of childbirth, was admitted to the emergency room with an acute abdomen. An abdominal enhanced computed tomography (CT) revealed retroperitoneal hemorrhage, leading to life-threatening, and multiple tumors in the liver. Additionally, chest CT also revealed multiple coin lesions in the lung. These findings strongly indicated a spontaneous rupture of adrenal tumor. We performed exploratory laparotomy. An examination during surgery showed a rupture of adrenal tumor. En bloc resection of adrenal gland, tumor, and the kidney was performed. Pathological finding revealed the adrenal tumor was choriocarcinoma.

[Operative position suitable for transvaginal excision of urethral diverticulum or closure of urethrovaginal fistula].

Among the various surgeries in female urology, transvaginal excision of urethral diverticulum needs careful and meticulous procedures in order to avoid some operative complications, such as urethral stricture or urethrovaginal fistula. In the present report, we present a woman with urethral diverticulum who initially underwent transvaginal excision of diverticulum in the dorsal lithotomy position, but she was complicated with urethrovaginal fistula postoperatively. Unfortunately, we failed to repair her fistula when she underwent excision of the fistula in the dorsal lithotomy position. With reconsideration of an operative position useful for transvaginal surgery, we succeeded in fistula closure in the Jackknife prone reverse-lithotomy position, and thereafter, two subsequent patients with urethral diverticulum were successfully treated with transvaginal excision of diverticulum in this operative position. In the transvaginal approach to the peri-urethral disorders, the Jackknife prone reverse-lithotomy position was notably superior to the dorsal lithotomy position with the following advantages: (1) the surgeons can easily operate in a bright and large surgical site without any blind view. (2) the surgeons can dissect and suture safely and accurately. (3) the assistants also can help in the operation bimanually in the same view as the surgeon when the posterior vaginal wall is fixed with a retractor.

[A case of retrovesical leiomyoma].

We herein report a rare case of leiomyoma in the retroperitoneal space posterior to the urinary bladder. A 61-year-old man came to our department complaining of lower abdominal discomfort. Abdominal and pelvic computed tomographic scan revealed a retrovesical solid tumor on the cranial side to the left seminal vesicle. Diagnostic imaging suggested that the retrovesical tumor was a benign tumor such as leiomyoma or fibroma, and he underwent simple resection of this retrovesical tumor via reroperitoneal approach. Histopathological diagnosis was well compatible with image diagnosis of leiomyoma. He has been followed up for 6 months without recurrence.

The impact of obstructive sleep apnea syndrome on nocturnal urine production in older men with nocturia.

OBJECTIVE: To investigate the impact of obstructive sleep apnea syndrome (OSAS) on night-time secretion of brain natriuretic peptide (BNP) and antidiuretic hormone (ADH) in older men with nocturia accompanied by nocturnal polyuria. MATERIALS AND METHODS: One hundred six men with nocturia aged ≥ 60 years underwent full-night polysomnography to determine whether they had OSAS. Blood count, standard chemistry panel, BNP, urinary ADH, urinary creatinine (u-Cre), and urinary osmolarity were measured at 6:00 AM, and a frequency volume chart was recorded on the same day that polysomnography was performed. RESULTS: We evaluated 83 patients after excluding 18 with mild OSAS and 5 with nocturnal polyuria index <0.35. Participants with OSAS had higher apnea-hypopnea index (P < .0001) than those without OSAS. Body mass index and systolic blood pressure were higher in OSAS patients than those in the control group. BNP was higher in the OSAS patients than in the control patients (48.6 ± 41.4 vs 30.7 ± 31.5; P = .0006). On urinalysis, OSAS patients showed higher urinary sodium and u-Cre secretion than controls (24.7 ± 11.3 vs 16.2 ± 5.1; P <.0001). Urine osmolarity was also higher in OSAS patients than in the control patients (616 ± 172 vs 516 ± 174; P = .0285). There was no significant difference in urinary ADH and u-Cre (6.7 ± 10.4 vs 6.8 ± 7.8; P = .3617) between the 2 groups. CONCLUSION: Our results indicated that older men with nocturnal polyuria and OSAS did not compensate their fluid imbalance presented with decreased secretion of ADH but increased BNP level.

Clinicopathological review of 46 primary retroperitoneal tumors.

OBJECTIVES: To clarify the clinical factors including diagnostic imaging findings that may correlate with the histopathological malignancy in primary retroperitoneal tumors. METHODS: The clinical backgrounds and imaging findings of 22 benign and 24 malignant primary retroperitoneal tumors were retrospectively investigated, and the prognosis of patients with malignant retroperitoneal tumors was assessed. RESULTS: There were significant correlations between the presence of symptoms and malignancy (P < 0.01), as well as between the irregularity of tumor margins and malignancy (P < 0.01). On dynamic magnetic resonance imaging (MRI), 90% of malignant tumors showed early enhancement either with quick or slow washout, while 75% of benign tumors showed delayed and no enhancement (P < 0.002). All malignant and benign paraganglioma showed the same early enhancement with quick washout. Malignant lymphoma showed various enhancement patterns. The 2-year and 5-year cause-specific survival rates of the patients with malignant retroperitoneal tumors were 68.0% and 43.2%, respectively. All malignant lymphoma patients were mainly treated with chemotherapy after being diagnosed histologically. Malignant paraganglioma patients who could not meet complete resection needed chemotherapy for promising survival. CONCLUSION: The symptoms, the irregularity of the margins, and the specific enhancement pattern on the dynamic MRI may be important predictive factors of the primary malignant retroperitoneal tumors. Histological diagnosis was needed for malignant definition of paraganglioma because both benign and malignant paraganglioma showed similar clinical and imaging findings. Preoperative biopsy should be considered for selection of the appropriate treatment particularly in patients that are likely to have malignant lymphoma that could not be diagnosed definitively by the clinical and imaging findings.