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A retrospective analysis of enterovesical fistula treated at Chang Gung Memorial Hospital was conducted to determine the optimal diagnosis and management of this disease.The records of 41 patients who presented from 1984 to 1996 and had a final diagnosis of enterovesical fistula were retrospectively reviewed. The etiology, symptoms on presentation, diagnostic tools, and modality of treatment were analyzed.The majority of these cases were associated with malignancy (38, 92.7%), and the others with diverticulitis (2, 4.9%) and iatrogenic causes (1, 2.4%). In those with malignancy, 15 patients (39.5%) were found to have tumor recurrence. The most frequent symptom in enterovesical fistula was fecaluria (58.5%), followed by abdominal pain (22%) and dysuria (14.6%). Diagnostic tools included the barium enema, cystography, and cystoscopy; these methods could identify the fistula in 63.2%, 60%, and 53.8% of the patients, respectively. Methods of management included diversion only (39%), one-stage fistula repair (36.6%), and watchful surveillance (24.4%).Enterovesical fistula should be considered if fecaluria, pneumaturia, or persistent non-specific urinary tract infection present as the initial complaint. A thorough surgery for a possible underlying malignancy is mandatory when confronted with enterovesical fistula, since the incidence of inflammatory bowel disease is low in this area. An abdominal computer tomography (CT) scan, barium enema, and cystogram can be useful diagnostic tools. Treatment of this entity should be individualized according to each patients clinical status.

Fournier's gangrene (FG) is a fulminant and fatal infection of the genitalia. However, the clinical course is unpredictable. This study retrospectively analyzed the possible prognostic factors of FG.Data obtained from 57 patients treated for FG from January 1985 through December 1996 were retrospectively analyzed. Possible prognostic factors including age, diagnostic delay, hospital stay, underlying diseases, clinical symptoms, origins, extents, bacteriologic findings, diverting colostomy and mortality rate were all considered in the analysis.Patients with extensive or localized FG had mortality rates of 31.3% and 16.0%, respectively (p = 0.227). The mortality rates of patients with FG of anorectal, urogenital and non-specific origin were 30.3%, 0% and 40.0%, respectively (p = 0.712). The mortality rates of patients with FG of anorectal origin who received primary or secondary diverting colostomy were 16.7% and 40.0%, respectively. However, the mortality rate of patients with FG of anorectal origin who did not undergo diversion was 29.4%. The mortality rate of patients with FG presenting with septic shock at emergency was 53.8% as compared with 0% in those without septic shock (p0.001).Fournier's gangrene is a rapidly progressive and life threatening infection of the genitalia. Age, underlying diseases, origin, extent and fecal diversion can not be regarded as prognostic factors of FG. Early primary diverting colostomy may reduce the mortality rate in those with severe infection of anorectal origin. Presence of septic shock in those with FG is the most important and the only factor related to death.

Adrenal hemangiomas are rare, nonfunctioning benign tumors. They are well circumscribed and comprise of closely adjacent vascular channels of varying sizes that are lined with a single layer of endothelium. When they occur, they are frequently located in the skin and liver. There are no characteristic symptoms of adrenal hemangioma unless the tumor reaches a size large enough to exert pressure. To our knowledge, there have been 14 clinical cases of adrenal hemangiomas reported, all with similar pathologic features. We present 2 additional cases, which were identified incidentally after non-urologic complaints (epigastric fullness and low back pain in patient 1 and patient 2, respectively). In these 2 patients, the tumors were surgically removed and diagnosed postoperatively as adrenal hemangiomas. Preoperative radiologic findings on plain film and abdominal computerized tomography showed the characteristic round calcifications with translucent centers, typical of phleboliths, to be pathognomonic of adrenal gland hemangiomas. Unfortunately, this characteristic feature of adrenal hemangioma existed in only one case report. In conclusion, the preoperative diagnosis of adrenal hemangioma is difficult but should be kept in mind as being part of the differential diagnosis of adrenal tumors.

Radical prostatectomy is the most common and effective therapy for localized prostate cancer. But in addition to its surgical complications, even highly selected series carry a positive margin rate of 35 to 50%. Radiotherapy is another alternative for prostate cancer, but following radiotherapy there have been high positive biopsies reported. Cryosurgery, defined as in situ freezing and hence, devitalization of neoplastic tissues, has currently raised the interest of urologists in the management of localized prostate cancer or failed radiotherapy.Five patients underwent transperineal cryosurgery of prostate in Chang Gung Memorial Hospital. Among them, three cases were stage D, one stage B and another failed radiotherapy of stage C prostate cancer. All patients received hormone therapy too.PSA declined in 3 patients and biopsies showed intraductal neoplasia. All 5 patients suffered from urine incontinence and one persisted. No mortality has been reported.Cryoablation of the prostate is an alternative for treatment of prostate cancer.

For the storage of human transplanted organs, the benefit of "UW solution" has been proven especially in keeping a longer preservation time for the liver and pancrease; however, the value for kidney preservation was still debated. A total of 293 cases of renal transplantation were performed over 12 years in our hospital and 206 cases were cadaveric transplants. The latter ones were further divided into 3 groups, according to the immunosuppressive medication and preservation solution used. In the CsA treated groups, the ATN rates significantly decreased in those preserved with the UW solution than with the UR solution. Although the UW solution did not improve the graft survival in our series, it did save the cost for postoperative hemodialysis and shorten the hospital stay which made it cost effective.

Hypospadias is a common congenital anomaly in male newborns. The incidence is about one in 300 live male births. In the U.S., about 6000 boys with hypospadias are born each year. For this study, we collected 117 recent (with the last 5 years) cases (88 fresh and 29 referred) who received an operation in our department. We calculated the hypospadias location and the complication rate with the desire of finding out the relationships between them. Our overall complication rate is 51.3% which is much higher than other recent studies and may be related to a different distribution of the hypospadias locations.