[A Case of Penile Pyoderma Gangrenosum Treated by Urethrocutaneostomy without Penectomy].

We herein report a case of penile pyoderma gangrenosum that was successfully treated with prednisolone and by urethrocutaneostomy without penectomy. A man in his 50s visite dour department because of painful urination. Pyuria and redness of the external urethral meatus were present. Treatment for urethritis with antibiotics did not improve his symptoms, and a painful ulcer and fistula formation between the glans and urethra subsequently developed. Microbiological cultures revealed no growth, and punch biopsy showed only nonspecific inflammation, leading to a diagnosis of penile pyoderma gangrenosum. We initiated prednisolone (PSL) at 40 mg once daily following placement of an indwelling suprapubic cystostomy tube for dysuria. However, the treatment was ineffective. Therefore, the dosage of PSL was increased to 65 mg once daily. The ulcer disappeared， but urethral stricture remained. Six hundred days after PSL treatment, we performed urethrocutaneostomy. The patient became free of the cystostomy and was able to urinate spontaneously. In recent years, there has been an increasing number of reports of penile preservation in the treatment of penile pyoderma gangrenosum, but knowledge regarding which patients require urethral surgery is lacking. Urologists should keep in mind increased susceptibility to infection, pathergy and possible recurrence, when considering urethral surgery for penile pyoderma gangrenosum.

[Clinical study of enterovesical fistulas].

We conducted a retrospective review of 16 patients who were diagnosed with enterovesical fistula in our hospital between January 2000 and July 2013. The patient's median age was 74 years old and 4 were female. Most of the chief complaints were pneumaturia and fecaluria. There was a vesicosigmoidal fistula in 12 patients, an ileovesical fistula in 2, and a rectovesical fistula in 2. The main underlying cause was diverticulitis in 9 patients and a sigmoid colon carcinoma in 3. Diagnoses were made based on the findings of cystoscopy, barium enema, abdominal computed tomography and so on. Treatment varied in each case depending on the etiology and the patient's condition. The procedure was mostly open surgery, but laparoscopic sigmoidectomy was performed preserving the bladder in the two most recent cases.

Mercaptoacetyltriglycine-3 renogram is not superior to estimated glomerular filtration rate measurement for the prediction of long-term renal function after nephrectomy.

OBJECTIVE: To evaluate the clinical usefulness of effective renal plasma flow (ERPF) measured using preoperative mercaptoacetyltriglycine-3 (MAG3) renogram for the prediction of chronic renal insufficiency after nephrectomy. METHODS: A total of 47 patients underwent preoperative MAG3 renal scintigraphy and subsequent unilateral nephrectomy. Correlations between the 5-year postoperative estimated glomerular filtration rate (eGFR) and the preoperative ERPF of the contralateral kidney (cERPF), ERPF of the diseased kidney (dERPF), total ERPF (tERPF), cERPF to dERPF ratio, serum creatinine (sCr) level, eGFR, as well as the influence of preoperative comorbidities (diabetes, hypertension) on the postoperative eGFR, were evaluated with both univariate and multivariate analyses. RESULTS: Multiple linear regression analysis showed that preoperative cERPF significantly correlated with postoperative eGFR. However, a much stronger correlation was observed between the preoperative and postoperative eGFR. Multiple logistic regression analysis showed that only preoperative eGFR was a significant predicator of the development of advanced-stage chronic kidney disease (CKD). CONCLUSIONS: Preoperative MAG3 renogram is not superior to eGFR measurement as a prognostic indicator of long-term renal function after unilateral nephrectomy.

[Surgical management of inflammatory granuloma which developed following subcutaneous injection of leuprorelin acetate: a case report].

A case of granuloma which developed following a subcutaneous injection of leuprorelin acetate is presented. A prominent induration developed at the site of injection with a three-month type preparation, and radical retropubic prostatectomy and simultaneous excision of the granulomas were requested by the patient since they were large, infectious and painful. Our experience may indicate the necessity of conversion from leuprorelin acetate to other drugs (e.g., goserelin acetate, castration) if a local induration, caused by a subcutaneous injection of leuprorelin acetate, has developed to a large granuloma.

[A case of cecovesical and rectovesical fistulas secondary to mucinous adenocarcinoma of the cecum].

A hundred and nine cases of cecovesical fistula are described in the literature. Although its origin is usually reported to be appendicitis, we present a rare case of cecovesical and rectovesical fistulas secondary to mucinous adenocarcinoma of the cecum. An 84-year-old man was referred to our hospital with the chief complaints of fever and cloudy urine. An enterovesical fistula was seen on cystography, and cystoscopy showed a lot of mucinous fluid in the bladder and the papillary tumor arising from the enteric mucosa was identified through the fistula. Transurethral biopsy of the tumor revealed a mucinous adenocarcinoma of suspected colonic origin. At the operation, cecovesical and rectovesical fistulas secondary to cecal tumor were removed by right hemicolectomy, low anterior resection of the rectum and partial cystectomy.

Clear cell adenocarcinoma arising from abdominal wall endometriosis mimicking urachal tumor.

A 41-year-old woman presented with severe lower abdominal pain. She had a history of 2 cesarean deliveries. Magnetic resonance imaging (MRI) revealed a 4.3 × 4.6 × 4.8-cm mass on the urinary bladder dome. Preoperative diagnosis was invasive urachal tumor. Wide resection of the tumor was performed. The histopathological diagnosis was clear cell adenocarcinoma with endometriosis. MRI revealed normal-sized ovaries and uterus. The definite diagnosis of clear cell carcinoma arising from abdominal wall endometriosis was made. Adjuvant chemotherapy with paclitaxel and carboplatin (total 6 courses) was planned. The patient has thus far received 4 courses of this treatment.

Complications and the learning curve for a laparoscopic nephrectomy at a single institution.

BACKGROUND: We assessed our experiences in performing a laparoscopic nephrectomy, with regard to complications and the learning curve, during a 4-year period. METHODS: Between November 2000 and October 2004, a total of 78 laparoscopic nephrectomies were performed at our institution (37 radical nephrectomies, 30 nephroureterectomies and 11 simple nephrectomies). The patient charts were retrospectively reviewed to identify any operative and postoperative complications, and also to evaluate the operating time. RESULTS: A total of eleven complications (14.1%) occurred in our series (nine operative and two postoperative complications). All operative complications were due to vascular injuries (n=9), five (2.6%) of which required an open conversion. The operating time and the rates of complications decreased significantly as the surgeons' experiences increased. CONCLUSION: A laparoscopic nephrectomy could be performed as safely as previously reported. In addition, the learning curve for a laparoscopic nephrectomy appeared to be good over the initial 50 procedures at our institution.

Extraperitoneal laparoscopic ureterolithotomy in the supine position for impacted ureteral stones.

We describe initial experiences with extraperitoneal laparoscopic ureterolithotomy in the supine position. This method can provide adequate working space without the risk of mechanical bowel injury and nerve stretching specific to the flank position.

Laparoscopic partial nephrectomy for a renal tumor with tumor-feeding artery ligation: left renal cell carcinoma in the posterior mid zone.

The most serious problem regarding a laparoscopic partial nephrectomy is how to perform bloodless excision without causing renal ischemia in a limited working space. We report the case of a 65-year-old man with left small renal cell carcinoma in the posterior mid zone who underwent a laparoscopic partial nephrectomy through a retroperitoneal approach by carrying out the ligation of the tumor-feeding artery, but without clamping the renal pedicle. Both preoperative abdominal computed tomography (CT) and intraoperative ultrasonography revealed the tumor to be fully encapsulated. The tumor-feeding artery could be exposed by dissection from the renal hilum and, after an arterial ligation, tumor resection with a safety margin was smoothly performed with minimal bleeding. Postoperatively, CT revealed a limited defect of the renal parenchyma and excretory pyelography showed no urine leakage or urinary tract obstruction. The preoperative and postoperative creatinine levels were 0.66 and 0.69 mg/dL, respectively. As a result, a tumor-feeding artery ligation with a laparoscopic partial nephrectomy for left renal cell carcinoma in the posterior mid zone is considered to be an effective surgical modality which avoids renal ischemia and pelvic heat injury.