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We report two cases of clear cell adenocarcinoma arising in the urethral diverticulum. Case 1 occurred in a 79-year-old woman presenting with complaints of frequent micturition. Magnetic resonance imaging (MRI) revealed a localized urethral diverticular tumor. Transurethral resection of the tumor was performed, and the final histopathological diagnosis was clear cell adenocarcinoma. Anterior pelvic exenteration was performed. She had no recurrence 15 months after surgery. Case 2 occurred in a 79-year-old woman presenting with urinary incontinence. As in Case 1, MRI and histopathological findings of transurethral resection of the tumor revealed clear cell adenocarcinoma in the urethral diverticulum. Anterior pelvic exenteration and ileal conduit formation were performed. She had no recurrence 16 months after surgery. Clear cell adenocarcinoma in the urethral diverticulum is very rare. We review 17 cases of clear cell adenocarcinoma arising in the urethral diverticulum in Japan.

We report a case of seminal vesicle abscess associated with Zinner syndrome. A 26-year-old male was admitted to our hospital because of fever and right scrotal swelling. Ultrasound showed an enlarged epididymis and color Doppler ultrasound showed increased vascularity in the epididymis. We diagnosed the case as acute epididymitis and started intravenous antibiotic therapy. Four days after admission, remittent fever persisted and blood culture was positive for Staphylococcus aureus. We performed computed tomography, which showed a right seminal vesicle cyst abscess and right renal agenesis. Our diagnosis was an abscess associated with Zinner syndrome. Transrectal ultrasound-guided transperineal drainage was performed 30 days after admission because seminal vesicle abscess could not be controlled by conservative treatment. Eight days after the procedure, the patient was discharged. One year after the procedure, recurrence of seminal vesicle abscess has not been observed.

A 40-year-old woman withuntreated type II diabetes mellitus was discovered withcardiopulmonary arrest in her room. On admission, she had ventricular fibrillation. After cardiopulmonary resuscitation, her own pulse restarted. The plasma glucose was 722 mg/dl and venous PH was 6.704. Abdominal computed tomography revealed gas within the parenchyma of the left kidney. We diagnosed her with emphysematous pyelonephritis and conducted emergency nephrectomy. Urinary and blood cultures were positive for Escherichia coli. Antibiotic therapy was initiated with doripenem and she was restrictively treated with intravenous insulin to control her plasma glucose. On the 8th day of hospital stay, she underwent resection of the small intestine because of necrosis. After multidisciplinary therapy, she was discharged with complete resolution of the infection.

A 54-year-old man was admitted to internal medicine due to unidentified fever persisting for 3 months, and was examined. Then, he was referred to our department for suspected pyelonephritis. Although he was initially being treated for pyelonephritis, right epididymitis occurred during the course of treatment. Antibiotics were ineffective, and symptoms such as weakness and subctaneous nodules also appeared. We performed epididymectomy to differentiate this intractable epididymitis from other systemic diseases. Pathological findings were fibrinoid necrotic vasculitis of middle and small arteries. Of the diagnostic criteria for polyarteritis nodosa, 4 major symptoms and histological findings were satisfied. After we started oral administration of predonin, the fever went down and the creative protein level decreased immediatately.

We report two cases of clear cell adenocarcinoma arising in the urethral diverticulum. Case 1 occurred in a 79-year-old woman presenting with complaints of frequent micturition. Magnetic resonance imaging (MRI) revealed a localized urethral diverticular tumor. Transurethral resection of the tumor was performed, and the final histopathological diagnosis was clear cell adenocarcinoma. Anterior pelvic exenteration was performed. She had no recurrence 15 months after surgery. Case 2 occurred in a 79-year-old woman presenting with urinary incontinence. As in Case 1, MRI and histopathological findings of transurethral resection of the tumor revealed clear cell adenocarcinoma in the urethral diverticulum. Anterior pelvic exenteration and ileal conduit formation were performed. She had no recurrence 16 months after surgery. Clear cell adenocarcinoma in the urethral diverticulum is very rare. We review 17 cases of clear cell adenocarcinoma arising in the urethral diverticulum in Japan.

Steroid sulfatase (STS) deficiency is one of the causes of ichthyoses. STS genes on the X chromosome is responsible for this disease. Therefore, STS deficiency is also called X-linked ichthyosis. Herein we report a case of STS deficiency complicated by bilateral undescended testis. A5-year-old-boy with STS deficiency was referred to our hospital because of bilateral undescended testis. We performed bilateral orchiopexy.

We report a prenatal case of neonatal testicular torsion. A 0-day-old boy with left scrotal swelling from the time of birth was referred to us. The physical examination revealed left intrascrotal hard mass. The ultrasonography with doppler color flow showed heterogeneous parenchymal echogenicity and the lack of blood flow to the affected testis. Testicular torsion was suspected and emergent surgical exploration was performed. The left testis was necrotic with extravaginal torsion of the spermatic cord. Left high orchiectomy was performed, considering the possibility of inguinal hernia. The histopathological examination confirmed the necrosis of the left testis.

We report a case of recurring foreign bodies in the urinary bladder. A 67-year-old male inserted a foreign body into the urinary bladder during masturbation. Eight months later, he experienced a fever and went to a hospital where ultrasonography revealed a foreign body in his urinary bladder. Then, he was referred to our hospital for surgical treatment. The patient’s surgical record indicated that he had undergone the same operation 3 times in the past thirty years. The inserted foreign body was successfully removed by suprapubic cystotomy, and he was discharged 13 days after the operation. He was also evaluated by psychiatrists, but they diagnosed that he had no mental disorder. To our knowledge, this is the first report on the removal of a foreign body in the urinary bladder four times in the same patient.

A 17-year-old man presented with right hydrocele because of an athletic injury. His scrotum was hitwith a ball 2 months ago while playing baseball. He was diagnosed with post-traumatic hydrocele andunderwent needle puncture at another hospital 1 month after the trauma. However, the hydrocele did notimprove. Therefore, he was referred to our hospital for surgical treatment. For diagnosis of the traumatichydrocele testis, a hydrocelectomy was scheduled. When we opened the tunica vaginalis, we realized thatthe tunica albuginea had been ruptured and the testicular parenchyma had gushed out. We tried to replaceall the escaped testicular parenchyma into the tunica albuginea, but it was impossible. Therefore were moved some of the redundant testicular parenchyma, and replaced the remnants into the tunica albuginea. After the operation, right hydrocele and testicular atrophy did not occur. Traumatic testicular rupture complicated with hydrocele is rare.

A 67-year-old man visited an urological clinic with a chief complaint of urination pain. Cystourethroscopy and magnetic resonance imaging (MRI) examination revealed a bladder tumor (cT3bN0M0). Marked leukocytosis and respiratory distress with pleural effusion appeared. Pulse steroid therapy improved the general condition partially. The patient was sent to our hospital for further examination. Serum granulocyte colony-stimulating factor (G-CSF) and interleukin-6 (IL-6) were high and the pathological findings of bladder tumor obtained by transurethral resection (TUR) revealed an urothelial carcinoma that produced G-CSF and IL-6. Neoadjuvant systemic chemotherapy was performed along with use of steroid and sivelestat, which ameliorated the respiratory distress. After three courses of systemic chemotherapy, serum G-CSF and IL-6 normalized and cystoprostatectomy was performed. The patient has been in good health at 20 months after the surgery with no evidence of recurrence.

We report a case of seminal vesicle abscess associated with Zinner syndrome. A 26-year-old male was admitted to our hospital because of fever and right scrotal swelling. Ultrasound showed an enlarged epididymis and color Doppler ultrasound showed increased vascularity in the epididymis. We diagnosed the case as acute epididymitis and started intravenous antibiotic therapy. Four days after admission, remittent fever persisted and blood culture was positive for Staphylococcus aureus. We performed computed tomography, which showed a right seminal vesicle cyst abscess and right renal agenesis. Our diagnosis was an abscess associated with Zinner syndrome. Transrectal ultrasound-guided transperineal drainage was performed 30 days after admission because seminal vesicle abscess could not be controlled by conservative treatment. Eight days after the procedure, the patient was discharged. One year after the procedure, recurrence of seminal vesicle abscess has not been observed.

A 79-year-old man presented with a mass lesion under the left kidney that was revealed by abdominal ultrasonography. The retroperitoneal tumor was removed by transabdominal exploration. Histopathological diagnosis was a leiomyosarcoma. Seven years after the first operation, he presented with left flank pain. Computed tomography showed a mass lesion in the abdominal wall. Tumor resection was performed. The pathological diagnosis was recurrence of leiomyosarcoma. The patient remains free from disease recurrence 1 year after the second surgery.

A 20-year-old woman referred to our hospital for further examination of primary amenorrhea with high levels of testosterone (998 ng/ml). Inspite of having normal female external genitalia, she had 5cm deep blind-ending vagina, absence of uterus and ovaries with the karyotype of 46, XY. Abdominal magnetic resonance imaging localized bilateral intra abdominal structures, which indicated bilateral testes. Thus, she was diagnosed with androgen insensitivity syndrome(AIS) based on both clinical and karyotypic evidence. She underwent laparoscopic bilateral gonadalectomythrough a single incision at the navel and histological examination showed intratubular germ cell neoplasia (ITGCN). Her postoperative course was uneventful with less pain and a small surgical wound was onlyat the navel. Laparoendoscopic single site surgery (LESS) can be considered a surgical procedure for gonadalectomyin AIS patients.

A 79-year-old man presented with a chief complaint of difficulty in urination. Digital rectal examination and transrectal ultrasonography showed an enlarged prostate. Holmium laser enucleation of the prostate (HoLEP) was performed. Histological findings revealed diffuse large B-cell lymphoma by immunohistochemical studies. Pelvic Lymph nodes were swollen on fluoro deoxygiucose-positron emission tomography examination. Therefore, the disease was classified into clinical stage II according to Ann Arbor’s criteria. The patient achieved complete response after 6 cycles of combination chemotherapy with rituximab, pirarubicin, cyclophosphamide, vincristine, and prednisolone (R-THP-COP). Now, 1 year 8 months after the chemotherapy, he remains free of the disease.

Leiomyosarcomas of the spermatic cord are rare tumors which cause significant morbidity and mortality. We report a case of leiomyosarcoma in a 67-year-old man who presented with a left scrotal mass. Left orchiectomy with high ligation of the spermatic cord was performed with clinical diagnosis of scrotal tumor. The pathological examination revealed leiomyosarcoma arising from the spermatic cord. He was free of disease two years postoperatively.

We report a case of solitaryneurofibroma of the spermatic cord. A 48-year-old man was referred to our hospital with a complaint of a left inguinal mass. Magnetic resonance imaging (MRI) demonstrated a solid mass in the left inguinal region. The tumor was removed. Histopathological diagnosis was neurofibloma. He had no other findings of Von Recklinghausen disease. Onlya few cases of solitary neurofibromas of spermatic cord have been reported.

Steroid sulfatase (STS) deficiency is one of the causes of ichthyoses. STS genes on the X chromosome is responsible for this disease. Therefore, STS deficiency is also called X-linked ichthyosis. Herein we report a case of STS deficiency complicated by bilateral undescended testis. A5-year-old-boy with STS deficiency was referred to our hospital because of bilateral undescended testis. We performed bilateral orchiopexy.

We report two cases of penile fracture. Case 1 was in a 22-year-old male. He heard a cracking sound during urination and experienced acute penile pain and detumescence. He was admitted to our hospital on that day. Case 2 was in a 52-year-old male. He heard a cracking sound during sexual intercourse and experienced detumescence. He was admitted to our hospital on the next day. In both cases, magnetic resonance imaging (MRI) showed disruption of the tunica albuginea. We performed immediate surgical repair through localized incision. They had no perioperative complications. Several months after surgery, they reported subjectively good erection without penile curvature or pain. We found that MRI is a useful tool for the assessment of location of the tunica rupture and minimization of the surgical incision.

A 40-year-old woman withuntreated type II diabetes mellitus was discovered withcardiopulmonary arrest in her room. On admission, she had ventricular fibrillation. After cardiopulmonary resuscitation, her own pulse restarted. The plasma glucose was 722 mg/dl and venous PH was 6.704. Abdominal computed tomography revealed gas within the parenchyma of the left kidney. We diagnosed her with emphysematous pyelonephritis and conducted emergency nephrectomy. Urinary and blood cultures were positive for Escherichia coli. Antibiotic therapy was initiated with doripenem and she was restrictively treated with intravenous insulin to control her plasma glucose. On the 8th day of hospital stay, she underwent resection of the small intestine because of necrosis. After multidisciplinary therapy, she was discharged with complete resolution of the infection.

We report a prenatal case of neonatal testicular torsion. A 0-day-old boy with left scrotal swelling from the time of birth was referred to us. The physical examination revealed left intrascrotal hard mass. The ultrasonography with doppler color flow showed heterogeneous parenchymal echogenicity and the lack of blood flow to the affected testis. Testicular torsion was suspected and emergent surgical exploration was performed. The left testis was necrotic with extravaginal torsion of the spermatic cord. Left high orchiectomy was performed, considering the possibility of inguinal hernia. The histopathological examination confirmed the necrosis of the left testis.

We report a case of recurring foreign bodies in the urinary bladder. A 67-year-old male inserted a foreign body into the urinary bladder during masturbation. Eight months later, he experienced a fever and went to a hospital where ultrasonography revealed a foreign body in his urinary bladder. Then, he was referred to our hospital for surgical treatment. The patient’s surgical record indicated that he had undergone the same operation 3 times in the past thirty years. The inserted foreign body was successfully removed by suprapubic cystotomy, and he was discharged 13 days after the operation. He was also evaluated by psychiatrists, but they diagnosed that he had no mental disorder. To our knowledge, this is the first report on the removal of a foreign body in the urinary bladder four times in the same patient.

A 42-year-old woman presented with left renal tumor. Computed tomography showed a left renal tumor (6 cm in diameter) and a tumor thrombus at the left renal vein, which had equal density to fat tissue. She was diagnosed with malignant tumor, and underwent radical left nephrectomy and resection of thrombus. Pathological diagnosiswasangiomyolipoma with no findingsof malignancy. No signsof recurrence or metastasis have been observed for 8 months after the operation.

A 17-year-old man presented with right hydrocele because of an athletic injury. His scrotum was hitwith a ball 2 months ago while playing baseball. He was diagnosed with post-traumatic hydrocele andunderwent needle puncture at another hospital 1 month after the trauma. However, the hydrocele did notimprove. Therefore, he was referred to our hospital for surgical treatment. For diagnosis of the traumatichydrocele testis, a hydrocelectomy was scheduled. When we opened the tunica vaginalis, we realized thatthe tunica albuginea had been ruptured and the testicular parenchyma had gushed out. We tried to replaceall the escaped testicular parenchyma into the tunica albuginea, but it was impossible. Therefore were moved some of the redundant testicular parenchyma, and replaced the remnants into the tunica albuginea. After the operation, right hydrocele and testicular atrophy did not occur. Traumatic testicular rupture complicated with hydrocele is rare.

Leiomyosarcomas of the spermatic cord are rare tumors which cause significant morbidity and mortality. We report a case of leiomyosarcoma in a 67-year-old man who presented with a left scrotal mass. Left orchiectomy with high ligation of the spermatic cord was performed with clinical diagnosis of scrotal tumor. The pathological examination revealed leiomyosarcoma arising from the spermatic cord. He was free of disease two years postoperatively.

We report a case of solitaryneurofibroma of the spermatic cord. A 48-year-old man was referred to our hospital with a complaint of a left inguinal mass. Magnetic resonance imaging (MRI) demonstrated a solid mass in the left inguinal region. The tumor was removed. Histopathological diagnosis was neurofibloma. He had no other findings of Von Recklinghausen disease. Onlya few cases of solitary neurofibromas of spermatic cord have been reported.

A 67-year-old man visited an urological clinic with a chief complaint of urination pain. Cystourethroscopy and magnetic resonance imaging (MRI) examination revealed a bladder tumor (cT3bN0M0). Marked leukocytosis and respiratory distress with pleural effusion appeared. Pulse steroid therapy improved the general condition partially. The patient was sent to our hospital for further examination. Serum granulocyte colony-stimulating factor (G-CSF) and interleukin-6 (IL-6) were high and the pathological findings of bladder tumor obtained by transurethral resection (TUR) revealed an urothelial carcinoma that produced G-CSF and IL-6. Neoadjuvant systemic chemotherapy was performed along with use of steroid and sivelestat, which ameliorated the respiratory distress. After three courses of systemic chemotherapy, serum G-CSF and IL-6 normalized and cystoprostatectomy was performed. The patient has been in good health at 20 months after the surgery with no evidence of recurrence.

A 79-year-old man presented with a mass lesion under the left kidney that was revealed by abdominal ultrasonography. The retroperitoneal tumor was removed by transabdominal exploration. Histopathological diagnosis was a leiomyosarcoma. Seven years after the first operation, he presented with left flank pain. Computed tomography showed a mass lesion in the abdominal wall. Tumor resection was performed. The pathological diagnosis was recurrence of leiomyosarcoma. The patient remains free from disease recurrence 1 year after the second surgery.

A 42-year-old woman presented with left renal tumor. Computed tomography showed a left renal tumor (6 cm in diameter) and a tumor thrombus at the left renal vein, which had equal density to fat tissue. She was diagnosed with malignant tumor, and underwent radical left nephrectomy and resection of thrombus. Pathological diagnosiswasangiomyolipoma with no findingsof malignancy. No signsof recurrence or metastasis have been observed for 8 months after the operation.

A 20-year-old woman referred to our hospital for further examination of primary amenorrhea with high levels of testosterone (998 ng/ml). Inspite of having normal female external genitalia, she had 5cm deep blind-ending vagina, absence of uterus and ovaries with the karyotype of 46, XY. Abdominal magnetic resonance imaging localized bilateral intra abdominal structures, which indicated bilateral testes. Thus, she was diagnosed with androgen insensitivity syndrome(AIS) based on both clinical and karyotypic evidence. She underwent laparoscopic bilateral gonadalectomythrough a single incision at the navel and histological examination showed intratubular germ cell neoplasia (ITGCN). Her postoperative course was uneventful with less pain and a small surgical wound was onlyat the navel. Laparoendoscopic single site surgery (LESS) can be considered a surgical procedure for gonadalectomyin AIS patients.

A 79-year-old man presented with a chief complaint of difficulty in urination. Digital rectal examination and transrectal ultrasonography showed an enlarged prostate. Holmium laser enucleation of the prostate (HoLEP) was performed. Histological findings revealed diffuse large B-cell lymphoma by immunohistochemical studies. Pelvic Lymph nodes were swollen on fluoro deoxygiucose-positron emission tomography examination. Therefore, the disease was classified into clinical stage II according to Ann Arbor’s criteria. The patient achieved complete response after 6 cycles of combination chemotherapy with rituximab, pirarubicin, cyclophosphamide, vincristine, and prednisolone (R-THP-COP). Now, 1 year 8 months after the chemotherapy, he remains free of the disease.