Search

Bladder diverticulum is an outpouching of bladder mucosa through the musculature of the bladder wall. The incidence of bladder diverticulum in Taiwan is about 1.7% in children and 23.4% in adults. Intradiverticular carcinoma of urinary bladder is uncommon. It ranges from 0.8% to 14.3%. Here we report a case of urothelial carcinoma within a bladder diverticulum. A 60-year-old male patient had history of BPH under medical treatment and right ureteral stone treated with extracorporeal shock wave lithotripsy (ESWL). He presented with painless gross hematuria about 3 months after ESWL. Intravenous pyelography showed a filling defect within the bladder diverticulum. Histopathological diagnosis of low grade urothelial carcinoma arising from the bladder diverticulum was made following cystoscopic biopsy. Laparoscopic partial cystectomy was performed with subsequent intravesical chemotherapy. Tumor recurrence was found not from the previous diverticulum but from another area during regular cystoscopy at the 6-month postoperative follow up. He underwent transurethral resection of bladder tumor. Pathology revealed a noninvasive, high grade urothelial carcinoma. There was no further bladder tumor recurrence during the 1-year follow-up period. Bladder-sparing surgery with close cystoscopy follow up for intradiverticular urothelial carcinoma can be applied as an alternative treatment modality. [ABSTRACT FROM AUTHOR]

Summary: Background/Objective: Standard laparoscopic adrenalectomy requires early control of the main adrenal vein; however, the small retroperitoneal working space is challenging for beginners to perform this maneuver. We report a technical modification of retroperitoneal laparoscopic adrenalectomy (RLA) for primary hyperaldosteronism (PHA) and the clinical outcomes. Methods: A total of 38 RLAs were performed for the patients with PHA. The patients were placed in true lateral position with mild bending to expand the surgical field. Instead of attempting to control the main adrenal vein initially, we adopted a technical modification that manipulating and freeing the gland first before controlling the main adrenal vein. Results: The RLAs were successfully performed in all but one case, which was converted to open surgery due to pancreatic injury. Mean operative time was 124 minutes and estimated blood loss was 74 ml. Mean maximal fluctuation of systolic blood pressure was 29 mmHg. For the right-side RLA, less operative time (113.5 vs. 137.9 minutes) and estimated blood loss (59.5 vs. 91.2 ml) were noted compared with the left-side procedure. Postoperative complications included cerebrovascular accident in one patient, one surgical site hematoma, and two patients had postoperative fever. Potassium level returned to normal in all patients and 70% of the patients reduced their antihypertensives. Conclusion: Technical modification RLA for PHA without initial control of the main adrenal vein is a safe and feasible procedure. No vigorous blood pressure fluctuation was intraoperatively noted. No vascular injury occurred. Moreover, the right-side procedure became easier. [Copyright &y& Elsevier]

Objective: Because of patients'' fear of surgery, the psychological symbolism of the male character, and significant encouragement by urologists, the majority of patients with advanced prostate cancer prefer medical castration as a choice of hormonal treatment. We investigated how the preserved testes were affected by medical castration with luteinizing hormone-releasing hormone (LH-RH) agonist and/or antiandrogen therapy. Materials and Methods: Thirty-four consecutive patients with advanced prostate cancer who underwent a bilateral epididymal-sparing orchiectomy were enrolled in this study. Before surgery, 19 of them had received LH-RH agonists and/or antian-drogens, while the other 15 patients had not. Morphological measurements were made immediately after the operation, and a histological examination was performed by a uropathologist with confirmation by urologists. The axial length, weight, and histopathological findings of the testes and prostate-specific antigen (PSA)/tes-tosterone level were compared between the two groups. Histological changes and characteristics were recorded and analyzed. Results: The median axial length and weight of the testes in the 19 patients with prior medical castration were 2.6 (2.0–3.6) cm and 8.0 (6.0–11.5) g, which significantly differed from those with primary surgical castration [4.0 (2.9–5.0) cm and 12.0 (9.0–17.0) g, both p< 0.001]. Moreover, profound atrophic and fibrosclerotic changes were noted in the seminiferous tubules in the group with prior medical castration. Specific findings, including basement membrane thickening and interstitial cell hyperplasia, were noted in specimens with prior medical castration. However, the postoperative serum PSA and testosterone levels did not significantly differ between the two groups. Conclusion: Medical castration in patients with advanced prostate cancer indeed caused a significant reduction in the volume and profound pathological change in the testes, which may compromise a patient''s expectation of his self-image (symbol of sexual virility). [Copyright &y& Elsevier]

Abstract: Extrapulmonary small-cell carcinoma (EPSCC) is a rare small-cell carcinoma (SCC). It is recognized as a clinicopathological entity distinct from SCCs of the tracheobronchial tree. EPSCCs account for about 2.5% of all SCCs. SCCs of the kidney are an even rarer neoplasm. Abdominal pain and hematuria are the major clinical symptoms. Many cases are already advanced disease at diagnosis and have poor prognoses. Platinum-based chemotherapy seems to be beneficial for overall survival. We describe an 82-year-old male patient who was seen at the emergency room due to complaints of gross hematuria and right-flank pain. Computed tomography showed a large right renal tumor. Treatment modalities, pathologic features, survival outcome of this case, and a review of similar cases in the literature are presented and discussed. To the best of our knowledge, this is the 21st case of SCC of the kidney reported in the literature to date. It is also the first report in Taiwan of a primary SCC of the kidney with the tumor thrombus extending to the inferior vena cava which required a right radical nephrectomy. [Copyright &y& Elsevier]