A 47-year-old man presented with dysuria. The prostate-specific antigen level was 65.5 ng/mL. Retropubic radical prostatectomy and regional lymphadenectomy revealed moderately differentiated adenocarcinoma (Gleason score 3 + 4 = 7, pT2N0). Postoperative adjuvant hormonal therapy was started immediately. Three years later, hormonal therapy was changed to anti-androgen monotherapy. Monotherapy was continued for eight years and then discontinued because the PSA level was maintained at <0.04 ng/mL. However, biochemical recurrence occurred 12 months after adjuvant hormonal therapy was discontinued. A computed tomography scan showed left inguinal lymphadenopathy. Biopsy of the swollen inguinal lymph node revealed metastatic prostate cancer. We report a rare case of metastatic prostate adenocarcinoma only to the inguinal lymph nodes.
A 81-year-old male was referred to our emergency outpatient unit due to acute renal failure. The level of serum creatinine was 276 μmol/l. A CT scan showed bilateral hydronephroureter, large bladder stone (7 cm × 6 cm × 6 cm) and bladder wall thickness. He was diagnosed as post renal failure due to bilateral hydronephroureter. Large bladder stone is thought to be the cause of bilateral hydronephroureter and renal failure. To improve renal failure, we performed open cystolithotomy and urethral catheterization. Three days after the surgery, the level of serum creatinine decreased to 224 μmol/l. He was discharged from our hospital with uneventful course. Bladder calculus is thought to be a rare cause of renal failure. We summarize the characteristics of bladder calculus causing renal failure. We should keep that long-term pyuria and urinary symptom, and repeated urinary tract infection can cause huge bladder calculus and renal failure in mind.
A 70-year-old man presented with a left scrotal swelling. A computed tomography scan showed an 8-cm left scrotal mass and no metastasis. Radical orchiectomy with high ligation of the spermatic cord was performed. The tumor was classified as a high-grade leiomyosarcoma of the left testis. An intensive follow-up including repeated computed tomography scans was performed. A computed tomography scan 34 months after the surgery showed a retroperitoneal mass in front of the left kidney. Resection of the mass was performed. Microscopically, the mass was metastatic leiomyosarcoma. Intratesticular leiomyosarcoma is rare; only 18 cases have been reported. This is the first case in which leiomyosarcoma metastasized to the retroperitoneal space postoperatively. We herein review the literature and discuss how intratesticular leiomyosarcoma metastasized to the retroperitoneal space in this patient.
An 82-year-old male patient underwent open left lower-pole partial nephrectomy with a microwave tissue coagulator (Microtaze). Pathological findings showed clear cell renal cell carcinoma, pT1a, Fuhrman grade 2 with negative margins. Then 2 years later, he presented with urinary retention. His urine appeared cloudy and milky only after meals, but appeared normal at other times. He was diagnosed with chyluria after partial nephrectomy. Endoscopic sclerotherapy with silver nitrate was carried out, because his serum albumin decreased to 3.4 g/dL within 3 months. He had an uneventful postoperative course. His chyluria completely disappeared and has not recurred for 11 months. Although chyluria after nephrectomy is very rare, there is a possibility that the frequency of chyluria after partial nephrectomy might increase, because the number of partial nephrectomies continues to increase worldwide. We herein summarize this rare surgical complication and discuss the effectiveness of endoscopic sclerotherapy as a therapeutic tool.
A 66-year-old man had been receiving anticoagulant therapy for myocardial infarction with warfarin potassium (abbreviated as warfarin) 2 mg/day. Though he had been treated with tamsulosin hydrochloride 0.2 mg/day as diagnosis of benign prostatic hyperplasia, he experienced severe dysuria and wanted to undergo transurethral resection of the prostate. We decided to continue anticoagulant therapy because cardiologist judged that intermission of anticoagulant therapy could cause myocardial infarction. Warfarin 2 mg/day p.o. was replaced with heparin sodium (abbreviated as heparin) 5000 u x 2/day s.c. 6 days prior to surgery, and anticoagulant therapy was stopped on the day of surgery, but resumed on the following day. Purpura appeared around the extremities 18 days after the surgery. Although coagulation testing was normal, platelet counts had markedly been reduced (2,000/mm3). Platelet counts recovered to a level of 228,000/mm3 13 days after cessation of heparin. No other adverse effects were observed. Heparin-induced thrombocytopenia (abbreviated as HIT) was diagnosed clinically. We consider monitoring of platelets to be necessary because an increasing number of patients are on anticoagulant therapy in Japan, and accordingly, the use of heparin is likely to be increased.
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