Fungal Bezoars Mimicking an Enterovesica Fistula: A Unique Case Report.

Fungal colonization or infection of the urinary tract system is relatively common in patients with diabetes or a compromised immune system. However, fungal intravesical bezoars are extremely rare. We present a unique case with multiple, gas-holding fungals bezoars and emphysematous cystitis caused by Candida tropicalis.

Case report: relief of acute obstruction of the Detour subcutaneous pyelovesical bypass.

A 36-year-old patient was admitted to the emergency department with complaints of severe flank pain, nausea, vomiting, anuria, and general illness. Five months earlier, we had placed a subcutaneous pyelovesical prosthesis (Detour; Porges) of the ureter for treatment of a chronically dilated upper urinary tract in a solitary right kidney previously treated by double-J stenting. Ultrasonography of the right kidney revealed severe hydronephrosis. A percutaneous nephrostomy catheter was placed, and antegrade pyelography showed complete obstruction of the prosthesis. Urinalysis and culture demonstrated a Candida infection. A systemic antimycotic was administered, and fluid management was started. On the third day, diuresis appeared, and antegrade nephrostomography confirmed patency of the bypass.

Treatment of patients after failed high intensity focused ultrasound and radiotherapy for localized prostate cancer: salvage laparoscopic extraperitoneal radical prostatectomy.

INTRODUCTION: To evaluate the feasibility and efficacy of salvage endoscopic extraperitoneal radical prostatectomy (EERPE) in recurrent prostate cancer after failed high intensity focused ultrasound therapy (HIFU), external beam radiotherapy (EBT) and brachytherapy. PATIENTS AND METHODS: Twelve patients with mean age 63.3 years (48-74), mean preoperative PSA 12.7 ng/ml and mean prostate weight 48.8 grams were treated with salvage EERPE with curative intent for biopsy proven locally recurrent prostate cancer. Our group was consisted of four patients who have been treated in the past with HIFU, six with EBT and two with brachytherapy. Operative time, estimated blood loss, conversion to open surgery rate, transfusion rate and transurethral catheter time were recorded. Also functional outcome and short term oncological outcome were reviewed. RESULTS: Average operative time was 153 minutes. Mean blood loss was 238 ml. The procedure was completed in all cases with no difficulty and without intraoperative complications. There was no need for conversion to open surgery or transfusion. Mean total urethral catheterization time was 7.2 days. After mean follow-up of 20 months, 10 patients were completely continent, and 2 needed 1-2 pads per day. Three patients were potent before the surgical treatment, but no one reported potency postoperatively. Biochemical recurrence was observed in only one patient 12 months postoperatively. DISCUSSION: In the initial experience, salvage EERPE in experienced hands has minimal perioperative morbidity. Short term oncological and functional outcomes are encouraging but further studies and longer follow-up are required in order to assess the long-term outcomes.

Salvage laparoscopic extraperitoneal radical prostatectomy after failed high-intensity focused ultrasound and radiotherapy for localized prostate cancer.

OBJECTIVES: To investigate the feasibility and efficacy of salvage endoscopic extraperitoneal radical prostatectomy (EERPE) in cases of recurrent prostate cancer after high-intensity focused ultrasound therapy (HIFU) or radiotherapy. METHODS: Nine patients underwent salvage EERPE with curative intent for biopsy-proven, locally recurrent prostate cancer. Of these 9 patients, 3 had previously undergone HIFU and 6 radiotherapy. Perioperative parameters (operation time, estimated blood loss, conversion to open surgery rate, transfusion rate, transurethral catheter time), functional outcome, and short-term oncologic outcome were reviewed. RESULTS: Mean patient age was 63.3 years (range 48 to 74 years). Mean preoperative PSA value was 12.64 ng/mL and mean prostate weight was 49.2 g. Mean blood loss was 238 mL. There was no need for conversion to open surgery or transfusion. Mean operation time was 148 minutes, and mean total transurethral catheter time was 6 days. No intraoperative complications were reported. There was no clear difference in operation difficulty between the post-HIFU and postradiotherapy EERPE. After a mean follow-up of 17 months, 7 patients were completely continent, and 2 needed 1 to 2 pads per day. Three patients were potent before the surgical treatment, but no patient reported potency postoperatively. In 1 patient a PSA relapse (1.20 ng/mL) was recognized 12 months postoperatively. CONCLUSIONS: Salvage EERPE after failed HIFU and radiation therapy is a safe and efficient method to treat locally recurrent prostate cancer. Short-term oncologic and functional outcomes are promising, but further study should be made on the long-term oncologic outcomes of this technique.