Associations of Ultrasonographic Features with Scrotal Pain after Vasectomy

PURPOSE: Scrotal discomfort is a recognized complication of vasectomy, but the natural history and incidence of this problem are uncertain. The typical ultrasonographic changes after a vasectomy primarily include epididymal thickening and epididymal tubular ectasia with diminished blood flow in the epididymis. We prospectively studied the differences in the ultrasonographic features of the testis and epididymis between patients with and those without scrotal discomfort after vasectomy. MATERIALS AND METHODS: We prospectively assessed pain scores in 178 men who underwent outpatient bilateral no-scalpel vasectomy at our institution between January 2009 and December 2010. At 2 months after vasectomy, we evaluated the postoperative scrotal pain questionnaire and scrotal ultrasonographic features for patients who returned for semen analysis. On the basis of the scrotal information, we investigated the potential relationships between scrotal pain or discomfort and scrotal ultrasonographic features of both testes and epididymides. RESULTS: The average age of the 114 men was 36.3 years (range, 29 to 53 years). group 1 (n=23), which reported scrotal pain or discomfort, showed no significant mean differences in the maximal diameter of the head of the epididymis when compared with group 2 (n=91), who had no scrotal pain or discomfort. Also, the width of the body of the epididymis between the two groups showed no significant differences. CONCLUSIONS: There were no significant differences in ultrasonographic features according to the presence of chronic scrotal discomfort after vasectomy. Therefore, causes of scrotal pain other than obstruction may need to be considered after vasectomy.

Segmental Testicular Infarction Treated with Partial Orchiectomy / 대한남성과학회지

Segmental testicular infarction is a rare cause of acute scrotum. Its etiology is not well defined and it can be clinically confused with a testicular tumor. Imaging studies play an important role in the preoperative diagnosis, with a Color doppler ultrasonography as the investigation of choice although magnetic resonance imaging (MRI) can be useful in doubtful cases. We report a case of segmental testicular infarction treated with partial orchiectomy seen in a 58-year-old man with right scrotal pain.

The Efficacy of Routine Sextant Prostate Biopsy Plus Selective Lesion-directed Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: The systematic routine sextant biopsy technique has been widely used in diagnosing prostatic cancer. But this technique may not include an adequate sampling of the prostate. We conducted a prospective study to evaluate the efficacy of the routine sextant prostate biopsy plus selective lesion-directed prostate biopsy method. MATERIALS AND METHODS: 120 men with abnormal digital rectal examination (DRE) and/or prostate-specific antigen (PSA) > or = 4.0ng/ml underwent a total of 122 routine sextant prostate biopsy (RSB) only or RSB plus selective lesion-directed prostate biopsy (SLB). SLB included one of the followings: digital-guided biopsy, hypoechoic lesion-directed biopsy or transitional zone biopsy if there were palpable nodule on DRE, hypoechoic lesion on transrectal ultrasonography (TRUS), or previous history of negative biopsy, respectively. RESULTS: The mean age of patients was 67.6 years (43-86) and the mean PSA level was 7.63ng/ml (0.47-over 155). 37.7% had cancer detected on biopsy. Detection rate in RSB plus SLB group (53.6%, 30 of 56) was higher than in RSB group (24.2%, 16 of 66). In RSB plus SLB group, 4 had cancer detected in SLB core(s) only. The positive rate of biopsy core was higher in the SLB core (72.9% (35/48)) than in the RSB core (54.4% (98/180)) (p= 0.022). CONCLUSIONS: In the presence of a suspicious lesion or the history of a previously negative biopsy, the addition of SLB or transitional zone biopsy may increase the detection rate of prostatic cancer.

Primitive Neuroectodermal Tumor of the Kidney / 대한비뇨기과학회지

Primitive neuroectodermal tumor (PNET), also referred to as extraskeletal Ewing's sarcoma, is a highly aggressive tumor, and it is seen typically in the soft tissues of the chest wall and paraspinal region but rarely arises in the kidney. A 27-year-old woman was presented with a left renal mass and underwent a radical nephrectomy. The pathological diagnosis was a primitive neuroectodermal tumor. Microscopically, there were sheets and lobules of cells with round to oval nuclei and coarse chromatin, as well as a Homer Wright rosette formation. Immunohistochemical analysis showed strongly positive staining of CD99 and negative staining of other neuroendocrine markers, such as synaptophysin and chromogranin.

Perforated Appendicitis Presenting as a Bladder Tumor in a 3 Year-Old Girl / 대한비뇨기과학회지

Large bladder masses in children are extremely rare pathological lesions. They can present as a gross hematuria, with irritable or obstructive voiding symptoms and a urinary tract infection. Their differential diagnosis must include for genitourinary malignancies, such as rhabdomyosarcoma, as well as benign inflammatory lesions. A case of a bladder mass in a three-year-old girl is reported, which was finally diagnosed as localized perforated appendicitis.