Transabdominal ultrasound-guided urethral catheterization with transrectal pressure.

BACKGROUND: Occasionally, difficulty with standard urethral catheterization is encountered. OBJECTIVE: We conducted a pilot study to evaluate whether transabdominal ultrasound (TAUS) showed the tip of a urethral catheter and whether TAUS-guided catheterization with transrectal pressure is successful in male patients in whom performing standard catheterization is difficult. METHODS: The eligible study participants included adult male patients in whom standard catheterization failed in our emergency department or who were transferred from other facilities after failure of catheterization and subsequent urethral bleeding. The enrolled patients included those in whom the tip of a catheter could not be advanced through the posterior and bulbar urethra judging from the inserted length. First, an emergency nurse advanced a catheter until the progress was obstructed. Next, an emergency physician performed TAUS to detect the tip of the catheter. If the tip was detected, the physician inserted the index finger into the rectum and kept pushing the site of the obstruction. After following these procedures, the nurse again advanced the catheter. RESULTS: Six patients were enrolled. The tip of a catheter was detected in the urethra or the false passage using TAUS in 4 of the 6 patients. In these 4 patients, the curve of the urethra became gentle or the false passage was compressed by transrectal pressure and the tip was advanced smoothly to the bladder. CONCLUSIONS: In some male patients in whom performing standard urethral catheterization is difficult, TAUS reveals the tip of the catheter and TAUS-guided catheterization with transrectal pressure can be safe and useful.

Impact of high-consistency area evaluated under hand-operated transrectal compression using a sonographic probe on prostate cancer detection: clinicopathological analysis.

Aim of this investigation was to determine whether the evaluation of a new dynamic finding on conventional greyscale transrectal ultrasonography (TRUS), which we named as high-consistency area (HCA), is useful in detection of prostate cancer (PCa). Fifty-one consecutive patients were prospectively enrolled in this study. When TRUS-guided prostate biopsy was performed, HCA that was difficult to transform, due to transrectal compression using sonographic probe, was evaluated. HCA-targeting biopsy, digital rectal examination (DRE)-targeting biopsy and systematic 12-core biopsy were performed. All biopsy cores were diagnosed histopathologically. As the results, twenty-three PCas were detected in 51 patients. The sensitivity and specificity of HCA-targeting biopsy for correct diagnosis were 60.9% and 78.6%, respectively. The sensitivity and specificity for DRE-targeting biopsy were 47.8% and 78.6%, respectively. In conclusion, HCA-targeting biopsy of this study was superior to DRE-targeting biopsy with regard to detection of PCa. Before prostate biopsy, patients should be evaluated for DRE and HCA, and DRE and HCA-targeting biopsy should be performed.

Malignant pericardial tamponade in a patient with hormone-refractory prostate cancer.

An 82-year-old man who was receiving treatment for prostate cancer and cholangiocellular carcinoma was admitted to our hospital because of chest discomfort and dyspnea. At the time of admission, 16 months after the start of hormone therapy, the prostate-specific antigen level was 454.08 ng/ml. Chest radiography revealed cardiomegaly, and ultrasonography demonstrated significant pericardial effusion. Pericardiocentesis yielded a hemorrhagic exudate, and a routine cytological study revealed malignant cells. It was difficult to determine whether these cells had originated from the prostate cancer or the cholangiocellular carcinoma. However, immunohistochemical analysis of a cell-block section of the pericardial effusion allowed a diagnosis of pericardial metastasis from the prostate cancer. After drainage and intrapericardial injection of cisplatin, the amount of effusion was decreased. After removal of the pericardial drain, the patient was discharged, but the pericardial effusion was found to have accumulated again 1 month later.

Aggressive angiomyxoma mimicking inguinal hernia in a man.

We report the case of a 37-year-old Japanese man who presented with a left lower abdominal mass that was initially interpreted clinically as an inguinal hernia. The patient reported a swelling in his left lower abdomen over the past 6 months. Magnetic resonance imaging revealed a left inguinal mass extending from the left spermatic cord to the left inguinal subcutaneous layer. Local excision was performed, with a preoperative diagnosis of benign soft tissue tumor. Histopathological diagnosis revealed aggressive angiomyxoma (AAM), and no recurrence was observed 6 months after surgery. AAM is a rare tumor which most commonly occurs in the pelvis or perineum of premenopausal women, with extremely rare cases in men. The findings from previously reported cases and our case suggest that AAM should be considered in patients with an inguinal or scrotal swelling with a suspicious soft tissue tumor.

[Placement of a shape-memory alloy intraurethral catheter (Memokath) using transrectal ultrasonography and fluoroscopy].

Intraurethral catheters are effective in the treatment of elderly patients with benign prostate hyperplasia (BPH) who have severe complications. However, it is not easy to measure the length of the prostatic urethra and to determine an appropriate location for the urethral catheter using only fluoroscopy, especially in patient with severe mid-lobe enlargement. We attempted to place a shape-memory alloy intraurethral catheter (MEMOKATH) by transrectal ultrasonography and fluoroscopy to measure the precise length of the prostatic urethra and to determine an appropriate location for an intraurethral catheter placement. Patients were given urethral infiltration anesthesia with 2% lidocaine hydrochloride jelly and placed in the supine position. Both transrectal ultrasonography and fluoroscopy were performed to observe the bladder neck, the apex of the prostate gland, and the prostatic urethra. Transrectal ultrasonography was shown to depict them more clearly than fluoroscopy. Transrectal ultrasonography was also shown to be more suitable than fluoroscopy for measuring the prostatic urethra length, as well as for accurately positioning the MEMOKATH stent, especially in cases of BPH with mid-lobe enlargement. The MEMOKATH stent was placed in 7 patients with BPH. Urethral catheters had been put in place in 6 of these patients because of urinary retention, and large amounts of residual urine were found in the remaining patient. Three patients had severe mid-lobe enlargement. All patients were able to urinate without much residual urine after the procedure. No severe complications were noted. Transrectal ultrasonography is useful for accurately placing the MEMOKATH stent, as it provides more objective and detailed anatomical findings than fluoroscopy.

[Testicular cavernous hemangioma associated with intrascrotal testicular torsion: a case report].

A 22-year-old man consulted our hospital with a left intrascrotal mass and a six-day history of dull pain in the left lower abdomen. Serum levels of tumor markers were normal. Testicular ultrasonography demonstrated a heterogeneous isoechoic mass in the left testis. Computed tomography revealed a left testicular mass with high density. A diagnosis of probable testicular malignancy was made, and left radical orchiectomy was performed. Intraoperative findings indicated torsion of the left testis. The testis was necrotic and the mass including the testis was extirpated. The histopathological diagnosis was testicular cavernous hemangioma. To our knowledge, only 20 cases of cavernous hemangioma of the testis have been reported to date, and this is the first report of testicular hemangioma presenting with torsion of the testis.

[A case of urinary retention caused by true phimosis].

We report a case of urinary retention caused by true phimosis in a 67-year-old man with untreated diabetes mellitus. The patient could not void in a stream, and urine dropped out of the external urethral orifice with manual compression of the penis. Subsequently, he visited our hospital due to urinary retention. Ultrasonography revealed right hydronephrosis and ballooning of the foreskin. An emergency dorsal slit was performed, and hydronephrosis showed immediate improvement. Histopathologically, fibrosis and inflammation of the foreskin were observed. The mechanisms responsible for urinary retention in this case are discussed.

Thrombolytic therapy for traumatic unilateral renal artery thrombosis.

We report a case of traumatic unilateral renal artery thrombosis that was successfully treated by thrombolytic therapy. The patient was a 17-year-old woman, who had put her left upper abdomen between a wall and the handle of a ground roller when using it. A computed tomography scan with intravenous contrast showed a lack of contrast in the left kidney. Angiography showed complete occlusion of the left renal artery, and the diagnosis was traumatic left renal artery thrombosis. Following angiography, thrombolytic therapy was performed. Urokinase was administered into the left renal artery, and 360,000 units per 1.5 h was required. Thrombus disappeared and flow of left renal artery was observed. Recovery of left renal function was seen on renoscintigraphy. Surgical maneuvers for traumatic renal artery thrombosis are autotransplantation or thrombectomy generally, but we think that thrombolytic therapy following angiography is a less invasive method and saves warm ischemic time.

[Non-ischemic partial nephrectomy using microwave tissue coagulator].

PURPOSE: The indications and the safety of non-ischemic partial nephrectomy using a microwave tissue coagulator were studied. MATERIALS AND METHODS: Non-ischemic partial nephrectomy was performed on 17 kidneys of 16 patients using a microwave tissue coagulator. The diagnosis was renal tumor and renal stones in eleven and five patients, respectively. Renal tumors were less than 4 centimeters in diameter, while the stones were associated with a caliceal diverticulum or secondary cortical atrophy. Excision of the tumors was done via the retroperitoneal approach through an oblique lumbar incision. The needle of the microwave tissue coagulator was inserted around the tumor (stone) 10 to 20 times, and the coagulator was activated. Then the tumor (stone) was excised with a sharp knife or scissors. Patients were encouraged to walk on the first postoperative day. RESULTS: Vascular clamping was necessary in one patient to reduce bleeding. Nephrectomy was done after partial nephrectomy in one patient because it was difficult to close the urinary collecting system after it was widely exposed. Although urine leakage was seen postoperatively in two patients, it ceased spontaneously at 14 and 23 days after surgery. Postoperative complications developed in one of seven patients (14%) with protruding renal tumor, in three of five patients (60%) with non-protruding renal tumor and in two patients with renal stone. Allogenic or autologous blood transfusion was not necessary, nor was any bleeding noticed post-operatively. In one patient, atrophy of the renal parenchyma occurred gradually after surgery and function was eventually lost. However, renal function was well preserved and recurrence of the problem was not observed in the other 15 patients, excluding one who died of esophageal cancer. CONCLUSIONS: The microwave tissue coagulator is a useful surgical instrument for non-ischemic partial nephrectomy, not only in patients with renal tumors but also in patients with complicated kidney stones. However, non-protruding renal tumor in a patient with solitary kidney should be avoided for this surgery. Thermal injury to the renal parenchyma or large vessels should be avoided and urine leakage from the collecting system should be meticulously treated during the operation.