Long-term follow-up of penile glans necrosis due to paraphimosis.

INTRODUCTION: Paraphimosis is a urologic emergency in which the foreskin of the penis becomes trapped behind the coronal sulcus and forms a tight band of constricting tissue. Surgical or conservative release of this constriction is required for the treatment. Delayed treatment will cause devastating outcomes, such as penile glans necrosis. A few studies have reported penile glans necrosis/gangrene, but long-term follow-up of the recovery from glans necrosis due to paraphimosis has not been previously reported. CASE PRESENTATION: A 25-year-old man who experienced glans necrosis following paraphimosis was not treated promptly with circumcision. The patient underwent conservative treatment with debridement of necrotic tissue and cystostomy for urethral meatal necrosis. We were able to prevent partial penectomy. His penile glans was covered with healthy epithelium and retained its natural shape and voiding and erectile functions were normal 2 years after the treatment. CONCLUSION: We report successful conservative management of penile glans necrosis.

[A case of squamous cell carcinoma of the bladder in a patient with interstitial cystitis].

A 60-year-old woman with interstitial cystitis (IC), who had previously received hydrodistention surgery, intravesical instillation of resiniferatoxin and medication, was being followed. Although urinary cytology was regularly tested with no positive findings, computed tomography carried out for screening of recurrent colon cancer showed muscle-invasive squamous cell carcinoma (SCC) of the bladder (cT3bN0M0). Cystectomy was performed, but she died due to rapid disease progression at 3 months postoperatively. Chronic inflammation can be the cause of development of SCC. It is dubious whether the specific treatments for IC affected her disease. In cases of IC with persistent pyuria, the development of SCC should be kept in mind, and affirmative examination including cystoscopy should be done regularly for early detection of the disease.

[Adenomatoid tumor of the testis with testicular pain: a case report].

A 30-year-old man who complained of sudden right scrotal pain visited our clinic. Physical examination revealed a palpable mass with tenderness on his right testis. An emergent operation was performed for acute scrotum. The intraoperative findings showed a small, white, elastic solid, a smooth surface tumor that originated from the tunica albuginea of the right testis. It seemed to be benign macroscopically and partial orchiectomy was performed. Soon after surgery, the pain disappeared. Pathohistological examination revealed an adenomatoid tumor of the testis which originated from the rete testis. Adenomatoid tumor of the testis is a rare benign tumor. In general, it can be diagnosed by observation of an incidental, pain-free and small palpable mass of the testis. Therefore, we should be aware that an adenomatoid tumor of the testis can be one of the differential diagnoses of acute scrotum.

Septic pulmonary embolism caused by Candida albicans after treatment for urinary multidrug-resistant Pseudomonas aeruginosa.

After treatment with antimicrobial chemotherapy for the elimination of urinary multidrug-resistant Pseudomonas aeruginosa (MDRP), a 48-year-old man with recurrence of bladder cancer complained of acute onset of dyspnea, and computed tomography revealed multiple nodular lesions in the lung. Candida albicans was isolated from both urinary and blood samples. He was diagnosed as having a septic pulmonary embolism caused by C. albicans. Fungal septic pulmonary embolism is a rare condition; however, we must be cautious about superinfection as a consequence of strong antimicrobial chemotherapy, and understand that the treatment for urinary MDRP is likely to be difficult.

Preoperative computed tomography finding predicts for postoperative inguinal hernia: new perspective for radical prostatectomy-related inguinal hernia.

OBJECTIVES: To investigate the incidence of radical prostatectomy-related inguinal hernia (RPRIH) and the predictive factors for RPRIH. METHODS: We reviewed the medical charts of patients who had undergone retropubic radical prostatectomy (RRP) at our institution from January 2002 to December 2004 and had a median follow-up of 17 months (range 3 to 42). All patients were examined for RPRIH every 3 months. We also reviewed the computed tomography results in a blinded manner and investigated the predictive factors for RPRIH with multivariate analysis using the Cox proportional hazards model. RESULTS: Of 98 patients analyzed, 17 were diagnosed with RPRIH after RRP (17.3%) at the median of 7 months (range 3 to 12). Preoperative computed tomography results were available for all patients, and subclinical inguinal hernia was identified in 20 (20.4%) of the 98 patients. Multivariate analysis showed that a subclinical inguinal hernia was the single predictive factor for RPRIH. The estimated rate of RPRIH was 60.6% in the subclinical inguinal hernia group and 9.5% in the normal group at 12 months (log-rank test, P <0.001). CONCLUSIONS: The results of the present study have indicated that a preoperative computed tomography finding of a subclinical inguinal hernia predicts for postoperative inguinal hernia formation after RRP. RRP might only advance the time at which the inguinal hernia would develop with or without surgery. Thus, all patients with a subclinical inguinal hernia finding should be informed about the possibility of the development of RPRIH within 12 months after RRP and recommended to undergo surgical repair at RRP.