Intrascrotal calculi: a very rare stone disease.

A stone in the hydrocele sac is very rarely encountered, whereas the occurrence of multiple stones in the hydrocele cavity has not been reported before. Numerous intrascrotal stones were encountered in the hydrocele sac of a patient during operation and has prompted us to report this case.

Results of dorsal midline plication in children with penile curvature and hypospadias.

OBJECTIVES: To present our initial results using dorsal midline (12-o'clock position) plication in children with penile curvature and hypospadias. METHODS: Twenty-five children with hypospadias and ventral curvature confirmed after artificial erection underwent dorsal midline plication and hypospadias repair. Ventral curvature was corrected by making a 5 to 10-mm-long vertical incision through the tunica albuginea at the dorsal midline and approximating the outer edges of the incision with a monofilament polydioxanone stitch. RESULTS: One plication suture was needed in 15 patients. In 8 patients with mid-shaft hypospadias and 2 with proximal penile hypospadias, two and three sutures were needed, respectively. In none of the patients was division of the urethral plate needed, except for one with proximal hypospadias. No complications were encountered during a mean follow-up of 9 months (range 5 to 34). CONCLUSIONS: We believe that most cases of penile curvature with hypospadias can be corrected using dorsal midline plication of the tunica albuginea. Although long-term follow-up is necessary after puberty to confirm any erectile or sensory advantage, this approach might be considered whenever plication is to be performed.

Significance of thrombocytosis for determining prognosis in patients with localized renal cell carcinoma.

OBJECTIVES: To evaluate the significance of thrombocytosis for determining survival in patients with localized renal cell carcinoma (RCC) who underwent radical nephrectomy with curative intent. METHODS: The study population comprised 151 patients who underwent radical nephrectomy with a diagnosis of localized RCC. The inclusion criteria were at least one preoperative platelet count and a tissue diagnosis of RCC. Thrombocytosis was defined as a platelet count greater than 400,000/mm3. The charts of these patients were retrospectively reviewed and the relationship between the preoperative platelet counts and survival was evaluated according to the histologic variants. RESULTS: The mean follow-up was 37.1 +/- 24.1 months (median 34, range 3 to 91). Of these 151 patients, 21 had a preoperative platelet count greater than 400,000/mm3. The thrombocytosis rate was significantly greater in those with advanced T stage (P = 0.045). Lymph node positivity also correlated with thrombocytosis (P = 0.028). However, no statistically significant correlation was found between grade and histologic subtypes and thrombocytosis (P = 0.053 and P = 0.354, respectively). Ten (47.6%) of 21 patients with thrombocytosis and 21 (16.2%) of the remaining 130 patients died of disease progression (P = 0.002). The Kaplan-Meier cause-specific survival curves showed that patients who had thrombocytosis had a mean survival of 45.2 months compared with 76.6 months in patients without thrombocytosis (P = 0.0002). CONCLUSIONS: Preoperative thrombocytosis is a significant predictor for determining prognosis in patients with localized RCC. Thrombocytosis was found more frequently in patients with advanced stage RCC, and patients with preoperative thrombocytosis had a worse survival compared with those with normal platelet counts.

Thrombospondin-1, vascular endothelial growth factor expression and microvessel density in renal cell carcinoma and their relationship with multifocality.

OBJECTIVE: To evaluate the relevance of microvessel density (MVD) and the angiogenic factors, vascular endothelial growth factor (VEGF, an important angiogenic factor in solid tumors) and thrombospondin-1 (TSP-1, a potent inhibitor of angiogenesis), to multifocality of renal cell carcinoma (RCC). PATIENTS AND METHODS: Using immunohistochemistry the expression of CD34, TSP-1 and VEGF was assessed in 38 archival tissue specimens from 19 patients with unifocal RCC and 19 with multifocal RCC. Immunostaining results for VEGF was scored for the appropriate percentage of positive tumor cells and relative immunostaining intensity (score range 0-12). Only extracellular immunoreactivity was considered positive for TSP-1 and the same method was used to score the stromal staining. The microvessel density was measured by immunohistochemical staining with anti-CD34 monoclonal antibody. RESULTS: VEGF immunoreactivity> or =1% was detectable in all unifocal and multifocal tumors. TSP-1 immunoreactivity was detected in 14 (73.7%) of 19 unifocal RCCs and in 16 (84.2%) of 19 multifocal RCC specimens (p=0.69). There were no statistically significant differences in the immunostaining intensity, percentage of immunopositive cells and the staining scores of VEGF and TSP-1 among the two groups. Additionally, there was no difference in MVD in multifocal and unifocal tumors. CONCLUSION: As there is no difference in MVD count, and expression of angiogenic factors (VEGF and TSP-1) in multifocal and unifocal tumors, multifocality of RCC is not determined by VEGF/TSP-1 expression.