[Urethral disruption treated by echo guided endoscopic management: a case report].

We report a case of 63-years-old man with a chief complaint of urinary retention and urethral meatal bleeding due to straddle injury. Urological examination revealed proximal bulbous urethral disruption with 1 cm gap, and then cystostomy was placed. Afterwards, urethral disruption was treated by echo guided endoscopic urethroplasty. Transurethral resection of scar tissue was performed twice for postoperative urethral stricture. Postoperative voiding cystourethrography revealed no urethral stricture. The patient voids well without urinary incontinence and erectile dysfunction. Recently, endoscopic urethroplasty, which is easy, minimally invasive, and repeatable in comparison with open urethral reconstruction, has been frequently performed for urethral disruption as endoscopic instruments functionally develop. Echo guided image in the present case is so useful that proximal and distal end of urethral disruption can be shown in same plane, indicating that primary urethral tract can be reconstructed without injury of rectum and urethra.

[A case of multiple renal hemangioma].

A 53-year-old man presented with a right heterogeneous renal tumor detected by ultrasonography (US) on a routine health check. He had no complaint. Computed tomography (CT) revealed a 4 cm-diameter heterogeneous tumor located near a calcification of the right kidney, which was not so enhanced. Subsequent magnetic resonance imaging (MRI) and angiography could not rule out the malignancy of the tumor, so we performed total nephrectomy. Pathological diagnosis was multiple renal hemangioma. Multiple renal hemangioma is a rare disease, being the second reported case in the Japanese literature.

[Intraluminal ureteral hematoma complicating anticoagulant therapy].

Intraluminal ureteral hematoma is a rare disease and only a few cases have been previously described. We report a case of intraluminal ureteral hematoma induced by anticoagulant therapy. A 65-year old man having the oral anticoagulant therapy for prevention of secondary thrombolism following atrial fibrillation was referred to us for gross hematuria. Ultrasound sonography (US) revealed right renal mild wide pelvis. Computed tomography (CT) showed the right ureteral submucosal hematoma. This ureteral hematoma penetrated the ureteral mucosa and caused macrohematuria. The patient had been anticoagulated on Warfarin with Bucolome for 18 days, so the prothrombin times (PT) was found to be excessively prolonged beyond the normal therapeutic range. The oral anticoagulation was stopped and intravenous Vitamin K2 was given, so PT was normalized. Though estimate hemorrhage quantity reached 1,200 ml, we had no blood transfusion. The hematoma was completely diminished 4 months later, no reccurence has been occurred. Bucolome has especially pharmacokinetic positive interaction to Warfarin, so we must check PT-INR frequently.