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A 27-year-old man visited our hospital with painless swelling of the left scrotum. Hematologic studies showed the following levels of lactate dehydrogenase, 3, 171 IU/l ; alpha-fetoprotein, 2.2 ng/ml ; and β- human chorionic gonadotropin, 0.4 ng/ml, and abdominal computed tomography revealed a mass of 10×8 ×4 cm in the left testis, and that of 3.5×3.0×5.0 cm in the left renal hilar lymph node, without any other metastasis. Left high inguinal orchiectomy was performed, and histopathological examination revealed mixed form with seminoma and teratoma. He was diagnosed to have a left germ cell tumor with left renal hilar lymph node metastases, pT1, N3, M0, stage II C, indicating poor prognosis with IGCCC. The patient received four cycles of chemotherapy, COMPE regimen (CDDP, VCR, MTX, PEP, VP-16 [etoposide]). After lactate dehydrogenase, alpha-fetoprotein, and β -human chorionic gonadotropin all normalized, retroperitoneal lymph node dissection was performed. Histopathological examination revealed only a mature teratoma. Two and half years later, hematologic studies showed blast transformation. Bone marrow biopsy revealed acute myeloblastic lymphoma (M2). The patient received one cycle of AraC and daunorubicin, one cycle of high dose AraC, and three cycles of AraC and mitoxantrone. After chemotherapy, he has maintained a disease-free status for 11 years. In this case, etoposide, a topoisomerase II inhibitor, was the presumed cause of therapy-related acute myeloid leukemia. After administering chemotherapeutic agents especially etoposide, it is important to check blood count periodically for a long time.

Anticoagulant and antiplatelet medications are commonly used for the treatment and prevention of cardiovascular diseases. We studied 84 patients who received heparin as a bridging anticoagulant and antiplatelet therapy during the perioperative period. Hospitalization was extended for adjusting anticoagulant and antiplatelet drugs and also bleeding complications in the perioperative period. There were 25 instances of bleeding complications (29.7%) in this study. These complications mainly occurred when anticoagulant and antiplatelet medications were restarted in the postoperative period. In transurethral surgery, patients taking warfarin and antiplatelet drugs (aspirin or ticlopidine) had a statistically significant increase in bleeding complications compared to patients taking warfarin alone. We compared 51 cases of transurethral resection of bladder tumor, transurethral resection of the prostate holium laser enucleation of the prostate, nephroureterectomy and percutaneous nephrolithotomy with heparinization were compared to 692 cases with no heparinization. The heparinization group had a statistically significant longer hospitalization period and an increase in bleeding complications. There was one instance of thromboembolism (1.2%) in our series. This involved stent thrombosis of a patient who had drug-eluting stent in the left anterior descending coronary artery. She died three days postoperatively. The number of patients taking anticoagulant and/or antiplatelet drugs is predicted to increase in the future due to aging of the population. Guidelines for the management of anticoagulant and antiplatelet therapy in the urological period are considered necessary.

We report a case of bilateral renal calculi in a 1-year-old female with adenine phosphoribosyl transferase (APRT) partial deficiency. She initially visited another institution with high fever as the major complaint. Computed tomography revealed a bilateral renal stone and left hydro nephrosis. In the urine, there were 2, 8-dihydroxyadenine (DHA) crystals. An analysis of the APRT gene revealed the APRT dificiency and the genotype to be APRT*J/APRT*Q0. We perfomed extracorporeal shock wave lithotripsy (ESWL) under general anesthesia, and as dissolution therapy we administered Meylon through the nephrostomy and citric acid orally. The stone disappeared from her kidney. The analysis of the stone fragments revealed 2, 8- dihydroxyadenine (DHA) urolithiasis.

To assess appropriate treatment strategies for transitional cell carcinoma in situ (CIS) of the upper urinary tract (UUT), we evaluated the long-term outcome of Bacillus Calmette-Guérin (BCG) perfusion therapy for CIS of UUT. We retrospectively reviewed the medical records of 24 patients who underwent BCG perfusion therapy for CIS of UUT between August 1993 and August 2009. Patients received at least one course of BCG (once weekly for 6 weeks). The median follow-up period was 48.5 months (range 16-201 months). In 23 patients (96%), cytology became negative after one course of BCG perfusion and 12 patients (50%) remained disease-free for a median follow-up of 38. 5 months. In 11 patients positive cytology recurred, and in five of them nephroureterectomy was performed after radiologic studies showed the presence of a tumor in the UUT. Histopathology showed invasive tumor (pT3) in all cases, and three of them experienced distant metastases after surgery. In conclusion, BCG perfusion therapy is effective for the treatment of CIS of UUT with long-term follow-up. However, in cases with a poor response or recurrence of CIS, there is a high risk of developing invasive tumor. Surgical intervention should be immediately considered in such cases after the first course of BCG perfusion therapy.

An adequate protocol for antimicrobial prophylaxis (AMP) in radical prostatectomy (RP) has not been established. We retrospectively compared the occurrence of perioperative infection following RP between two different AMP protocols. This study included 340 cases with prostate cancer who underwent RP at our institution between January 2005 and December 2008. The 1-day group consisting of 93 cases received a second generation cephem, cefotiam, intravenously during and after the operation on the operative day. The single dose group consisting of 247 cases received cefotiam during the operation only. The incidence of surgical site infection (SSI）and remote infection (RI) was retrospectively investigated. There was no significant difference in the rate of SSI and RI occurrence between the 1-day group (2.2, 0%) and single dose group (3.6, 0.4%) (p=0.52). The single dose protocol of AMP seems sufficient for prevention of perioperative infection in RP.

We aimed to investigate health-care seeking behavior related to lower urinary tract symptoms (LUTS) using a questionnaire-based survey. The questionnaire included questions related to 5 demographic issues, 9 past histories, 8 LUTS, and others about health-care seeking related to LUTS. We sent the questionnaire to 6, 000 residents, 41 to 70 years old, in three Japanese communities (Tobetsu, in a subarctic zone, Kumiyama, in a temperate zone, and Sashiki, in a subtropical zone). Of the questionnaires, 36.5% were valid for analyses. The prevalence of desire for treatment for LUTS was 15.6% (still-treated health-care seeker : 4.5%, never-treated health-care seeker : 11.1%). This finding suggested that, among residents with a desire for treatment, only 29% actually had treatment for LUTS. Multivariate analyses revealed that incomplete emptying, weak stream, and straining for males, and urinary frequency, nocturia, and incontinence for females were independently significant factors associated with health-care seeking related toLUTS.

We report a case of a 59-year-old woman who presented with gross hematuria due to development of a pseudoaneurysm that was diagnosed using Doppler ultrasonography 16 days after retroperitoneoscopic partial nephrectomy for renal cell carcinoma. Hematuria resolved after the patient was treated with selective angioembolization of the pseudoaneurysm. There has been no recurrence of the pseudoaneurysm for 28 months after the procedure.

A 48-year-old man presented complaining of lower abdominal pain, and was diagnosed with invasive bladder cancer. After neoadjuvant chemotherapy, cystoprostatourethrectomy and ileal conduit diversion were performed. At 53 years of age, bladder cancer recurred in the upper urinary tract and he underwent complete urinary tract extirpation. Histological examination revealed an urothelial carcinoma in an ileal conduit. Three years later, a local recurrence led to combined modality therapy including chemotherapy and radiotherapy. He is receiving maintenance chemotherapy for metastatic tumors. Urothelial carcinoma arising in an ileal conduit after radical cystectomy for bladder cancer is infrequently reported. To our knowledge, only 12 cases, including ours, have been reported.

Private hospitals in Japan appear to play an important role in the fertility preservation in cancer patients. However, only a few university-related institutions have published their data about sperm banking. Here we report our experience in a private hospital. The database of 5 years of experience with sperm cryopreservation for male cancer patients was reviewed. We assessed the type of cancer, timing of collection, sperm quality, and utilization for reproductive purposes. There were a total of 88 oncology patients who underwent sperm banking at our institution during the study period. Types of cancer were various, with testicular cancer and hematological malignancies comprising the largest groups. Nearly 90% of the testicular cancer patients had their sperm preserved prior to the therapy, while only 53% of those with hematological disease did so. Evaluation of semen parameters for these groups revealed that oligozoospermia in testicular cancer patients, even prior to initiation of cancer therapy, was common. Five patients utilized their specimens for reproductive purposes. Of these, 3 patients successfully fathered a child. Our results suggest that sperm cryopreservation before initiation of cancer therapy in male oncology patients is under-utilized. Additionally, there is minimal use of cryopreserved specimens for reproductive purposes. This under-utilization is supposed to be due to physicians', especially hematologists', insufficient awareness toward chemotherapy-related infertility and the paucity of reports regarding reproductive outcome after freezing. More data should be compiled to help both physicians and patients who are considering sperm cryopreservation., 京都市内で生殖医療を専門とした診療を行っている個人病院における長期精子凍結保存の実施状況を調査・検討した。解析対象は過去5年間に長期凍結保存を行った88症例とした。患者は全て他院からの紹介であり、紹介元の地域分類では京都府内が76%と最も多かったが、滋賀県や奈良県、さらには愛知県からの紹介もみられた。紹介患者の平均年齢は28.4歳で、未婚者が7割以上を占めていた。原疾患では精巣腫瘍が37.5%、血液疾患が44.3%を占めていた。紹介を受けたタイミングは、化学療法前の紹介が精巣腫瘍で9割近くに達していたが、血液疾患では約5割にとどまっていた。精液所見は乏精子症を34% に、精子無力症を57%に認めた。観察期間内に5例(4例は化学療法施行前に保存)で凍結精子を使用し、3例が妊娠・出産に至った。化学療法が生殖機能に及ぼす影響を詳細に検討するためにも、患者の定期フォローを可能にする体制が必要であると考えた。

著者らは112症例を対象に腎盂腫瘍と尿管腫瘍における病期別のリンパ節転移の陽性率および術後再発様式を後方視的に検討した。その結果, 1)≦pT1の病期では腎盂腫瘍, 尿管腫瘍ともにリンパ節陽性例は認めなかった。だが, pT2/3では腎盂腫瘍29%, 尿管腫瘍23%に陽性例を認め, 両腫瘍において明らかな差異は認めなかった。2)術後遠隔転移の頻度は≦pT1, ≧pT2ともに尿管腫瘍で高かった。局所再発は腎盂腫瘍に頻度が高い傾向を認め, その理由の一つとしてリンパ節郭清範囲の不十分さの関与が示唆された。3)cN+腎盂腫瘍症例や≧pT2尿管腫瘍症例においては, 所属リンパ節よりさらに広範囲な郭清が局所再発予防に有用である可能性が示唆された。4)リンパ節郭清非施行群において術後局所再発, リンパ節再発を来たした症例はなく, ≦pT1症例でのリンパ節転移の頻度が極めて低かったことから, ≦pT1のような症例を適切に選択すれば, 必ずしも全例にリンパ節郭清をしなくても外科的治療の意義を損なわないと考えられた。, To determine treatment outcomes for renal pelvic and ureteral tumors, we retrospectively evaluated the correlations between stage, area oflymphadenectomy (LND) and the recurrence pattern. Of 162 patients treated surgically for a urothelial tumor of the upper urinary tract from 1990 to 2006, we reviewed 57 renal pelvic and 55 ureteral, diagnosed as having either renal pelvic or ureteral tumors. We defined local recurrence as metastasis to the retroperitoneum, pelvis, and abdominal lymph nodes. Of the 112 patients, LND was performed in 76. No patient with pTis/a/1 disease showed pN(+); however, in pT2 < or = disease, 39% of the renal pelvis and 23% of the ureter cases exhibited nodal involvement. During follow up, 35 patients had relapse; 25 distant metastasis, 5 local recurrence, and 5 synchronous recurrence at both sites. In pT2/3 disease, the frequency of distant metastasis of a ureteral tumor was significantly higher than that in renal pelvic cases (55% vs. 19%, P = 0.0237). Local recurrence was found in 7 renal pelvic and 3 ureteral cases. Although all of these patients had previously undergone LND, local recurrence adjacent to the dissected area was confirmed in 6 cases. In pT2 < or = disease, ureteral tumors showed more frequent occurrences of distant metastasis, whereas local relapses adjacent to the dissected nodal areas were more prominent in renal pelvic cases. When deciding a therapeutic strategy in renal pelvic cases, careful consideration about an adequate region for LND appears important.

全国大学および癌センターを中心とした泌尿器科に対し, 長期精子凍結保存に関するアンケート調査を行い, 90施設から有効回答が得られた(回収率86%)。1)施設内で長期精子凍結保存を実施していたのは26.7%で, 非実施施設の7割が個人病院に紹介している現状が明らかになった。また, 保存を実施している施設でも, 担当している診療科は産婦人科が主であった。2)生殖医療に関するセンター化を行っている一部の施設を除くと, 長期精子凍結保存における現在の泌尿器科医の主な役割は, 長期精子凍結保存の必要性や施設の紹介等に関する患者説明にあるものと思われた。しかし, 説明対象, 実施方法については施設間で差があり, 今後エビデンスに基づいた標準化が必要と考えられた。, Questionnaires were mailed to 104 urological departments in universities, colleges, and cancer centers in February 2008. Ninety institutions returned answers to the questionnaire. Sperm cryopreservation before chemotherapy was performed in 24 institutions (26.7%) mainly in the gynecological department, whereas the others introduced the candidates to other institutions including private hospitals and clinics. Fifty-eight institutes gave information about fertility preservation routinely to young patients with testicular cancer before chemotherapy. Urological doctors in 57 institutions (63%) had no experience in consultation of patients with hematological/pediatric malignancies for fertility-preservation. Among 24 institutions performing sperm cryopreservation before chemotherapy, 18 preserved motile sperm even if during chemotherapy, as well as before chemotherapy but 2 institutions replied that patients during chemotherapy were contra-indication for sperm cryopreservation. For the patients with azoospermia, 2 institutions replied they tried to preserve testicular sperm before chemotherapy. The fee for sperm cryopreservation was free in 10 institutions. This nation-wide questionnaire survey clarified that the systems and indications for sperm cryopreservation before chemotherapy were different among institutions.

50歳代男性。鼻閉感を主訴とした。右腎細胞癌にて根治的右腎摘除術を, 右肺転移にて外科的切除術を施行した既往があった。頭部CTを施行したところ, 両側上顎洞内に造影剤で濃染される腫瘍を認めた。また全身検索として脳CT, 胸腹部CT, 骨シンチを施行し, 左腎に径2.2cmの腫瘍を認めた。上顎洞試験開洞術および腫瘍生検では約1000ccの出血を認め, 病理組織所見よりmetastatic renal cell carcinomaの診断であった。腎細胞癌両側上顎洞転移の診断で, 腫瘍血管塞栓術を施行後, 上顎洞を開放し両側とも可及的に腫瘍を摘除した。術後にはIFNαを600万単位/回, 3回/週を開始し, 両側上顎洞, 右篩骨洞に対して放射線外照射を直交2門で, total 45Gy(2.5Gy×18回)施行した。放射線療法終了後3ヵ月経過現在, 上顎洞内に明らかな腫瘍は認められない。また左腎腫瘍のサイズにも変化はなく, 外来にて経過観察中である。, A 58-year-old man presented with lasting nasal obstruction. He had undergone right nephrectomy for renal cell carcinoma 11 years ago and right lobectomy for pulmonary metastasis 10 years ago. Paranasal sinus CT scans showed a soft tissue mass in the bilateral maxillary sinus. Abdominal CT showed left renal mass. Each mass was enhanced on the contrast-enhanced viewing. The paranasal mass biopsy was performed and resulted in profuse bleeding. Pathological examination was a metastasic renal cell carcinoma. After embolization of feeding artery, debulking surgery was performed. Postoperatively he was given radiotherapy and interferon therapy.

Additional file 1. Charlson Comorbidity Score, Kaplanâ Meier of all-cause mortality and analyses predicting death in nocturic patients with Charlson Comorbidity Score 0-2.

60歳代女。2005年5月より上腹部痛があり、7月から左背部痛も自覚し翌月も症状改善がないため近医を受診した。上部消化管内視鏡検査で胃体部後壁に壁外性圧排所見を認め、腹部CTで左後腹膜に腫瘤を認めたため紹介となった。腹部触診で左季肋部に手拳大、可動性のある弾性硬の腫瘤を触知した。腹部CTで副腎と腫瘤の境界を認め、MRIでは腎と腫瘤の境界が明確でないことから腎被膜由来の肉腫を疑った。9月に経胸腹部切開で根治的左腎摘除術を行い、腎門部リンパ節郭清術を実施した。腫瘤は被膜を有し周囲組織との癒着は軽度で明らかな直接湿潤は認めず、腎と腫瘤との境界は明瞭でなく腎副腎を一塊に摘除した。摘出標本の病理所見で出血性副腎皮質腺腫に骨髄脂肪腫を合併したものと診断された。腫瘤と腎は顕微鏡レベルで明らかに離れており、腎由来の腫瘤であることは否定された。, We present a case of hemorrhagic adrenocortical adenoma with myelolipoma. A 66-year-old woman was admitted to our hospital for left retroperitoneal mass. Based on abdominal computed tomography, magnetic resonance imaging and blood tests, preoperative diagnosis was a sarcoma of renal capsule origin. En bloc resection of adrenal gland, tumor, and the kidney with lymph node dissection was performed. Histologically, the mass was diagnosed as hemorrhagic adrenocortical adenoma with myelolipomatous foci.

Urolithiasis in pediatric patients is relatively rare. Extracorporeal shock wave lithotripsy and endoscopic procedures play a major role in treating pediatric urolithiasis. A 3-year-old girl presented with macroscopic hematuria and right back pain and was diagnosed with a right renal stone (15 mm). Obstruction of ureteropelvic junction was suspected on computed tomography-urography and therefore the patient underwent percutaneous nephrolithotripsy (PNL). The operation was performed using a 12 Fr miniature nephroscope and Ho : YAG laser without any complications. This patient achieved a stone-free status. The stone analysis revealed a mixture of calcium oxalate and ammonium acid urate. PNL with a miniature nephroscope is safe and effective treatment for pediatric urolithiasis.

A 46-year-old woman with gross hematuria was referred to our hospital with suspicion of bilateral renal cell carcinoma. Computed tomography (CT) showed multiple renal tumors with contrast enhancement and multiple lung nodules. Based on a diagnosis of bilateral multiple renal cell carcinoma with multiple lung metastases, a combination therapy with interferon-alpha (IFN-α) and 5-flurouracil (5-FU) was initiated. Six months later, all the renal and pulmonary lesions remained the same, and IFN-α alone was continued thereafter. One tumor in the right upper pole decreased in size during the next six years, while all the other lesions remained unchanged. Then the immunotherapy was discontinued on the basis of possibility that the tumors could be benign lesions. Three years later, the right upper renal tumor disappeared on CT, but, one of the left renal tumors showed progressive disease. The patient underwent left partial nephrectomy together with resection of neighboring small tumors. All the excised tumors were diagnosed as chromophobe renal cell carcinoma on histological examination. There has been no change with the remaining tumors for 1.5 years postoperatively.

A 72-year-old man came to our clinic as a candidate of the donor of renal transplantation for his 44- year-old daughter. However, his serum PSA was found elevated, and he was diagnosed with stage C prostate cancer. He received neoadjuvant androgen deprivation therapy and subsequent IMRT as a definitive curative therapy. Since his PSA remained at a very low level after IMRT for three years, we performed systematic 16-site prostate biopsy, which revealed no viable prostate cancer cells. His renal function seemed to be normal and no functional difference was noted between the two kidneys. Then, his left kidney was harvested by hand-assisted retroperitoneal laparoscopic approach, and transplanted to his daughter successfully. The suitability of a donor with two potential problems-advanced age and a history of prostatic cancer-was discussed, together with a review of the literature.

A 32-year-old man was referred to our hospital for evaluation of bilateral renal tumors 8 cm each in diameter. His cousin also had a renal tumor, and she had been genetically diagnosed as von Hippel-Lindau (VHL) disease. Bilateral nephron-sparing surgery was performed in separate stages under clinical diagnosis of renal cell carcinoma and VHL disease. Histological examination revealed clear cell renal cell carcinoma (pT2). There was no evidence of local recurrence or metastasis 6 months after the second operation. In the treatment of renal cell carcinoma and VHL disease, nephron-sparing surgery is recommended to achieve a disease-free status without renal replacement therapy.

We present our clinical findings of laparoscopic nephropexy performed on a 32-year-old woman with symptomatic nephroptosis. Supine and erect excretory urography (DIP) revealed right renal descent of 2.5 vertebral bodies with hydronephrosis. Laparoscopic transperitoneal nephropexy was performed using nonabsorbable sutures, polyglactin net, hernial staplers and tissue adhesive. An upright DIP 1 month postoperatively revealed renal descent of only 1 vertebral body and no hydronephrosis. One year postoperatively, the patient is asymptomatic. A laparoscopic procedure, which is safe, effective and causes minimal morbidity, represents an excellent approach for repair of symptomatic nephroptosis.

69歳男。肉眼的血尿を主訴とした。超音波および排泄性尿路造影で左水腎症を, 造影CTでは左中部尿管に2cm大の腫瘤を認めた。左尿管尿での尿細胞診はclass Vであった。左尿管腫瘍cT2N0M0と診断し, 後腹膜鏡補助下左腎尿管全摘術および傍大動脈リンパ節郭清術を施行した。尿管腫瘍の剥離は直視下に行い, 周囲には十分な脂肪組織をつけた。リンパ節郭清は鏡視下および直視下で, 大動脈左側を腎茎部から大動脈分岐部まで行った。病理組織所見で腫瘍はN/C比の増大が目立つ異型細胞から成り, 尿管周囲脂肪織まで進展していた。免疫染色ではNSE, chromogranin A, CD56が陽性で, 尿管原発小細胞癌と診断した。術後化学療法および放射線療法として, シスプラチン, エトポシド, イリノテカンの3剤併用を2コースと, 原発部を含む後腹膜および大動脈周囲に計54Gy照射を行った。化学療法中にgrade 4の好中球減少を来たしたがG-CSF製剤投与で改善し, 術後14ヵ月経過して再発はない。, A 69-year-old man was referred to our hospital with a chief complaint of asymptomatic gross hematuria. After radiological evaluations, left nephroureterectomy with bladder cuff was performed under a clinical diagnosis of a left ureteral tumor (2 cm). Histological examination revealed a small cell carcinoma of the ureter (pT3, pN1). After the operation, adjuvant chemotherapy with irinotecan, etoposide and cisplatin was administered in combination with radiation therapy. At 14 months after the operation, there has been no evidence of recurrence. To our knowledge, this is the 22nd report of a small cell carcinoma originating from the ureter.

1992年1月～1996年12月の5年間における島田市民病院泌尿器科手術統計を行った.年間入院患者数は290人前後, 手術件数も年間平均200件(ESWLを除く)とほぼ一定数で推移していた.60歳以上の患者の割合は平均55.4%で, この5年間に一定の傾向は認められなかった.前立腺肥大症に対する手術は年間40件弱で, 前回(1987～1991年)統計に比べ約10%減少した.悪性腫瘍に対する手術は年間平均約50件で, 全体の24.4%であった.麻酔方法は全身麻酔21.0%, 腰椎麻酔46.4%であった

We report a case of bilateral breast metastases from prostatic carcinoma. A 49-year-old man with stage D2 prostate cancer, who had been treated by chemoendocrine therapy and radiotherapy for 2 years, complained of bilateral enlarged breasts. Oral administration of diethylstilbestrol diphosphate was started 2 months before the onset of this symptom. A firm mass that was not tender was palpable beneath the skin without fixation on each side. A needle biopsy of the masses showed poorly differentiated adenocarcinoma with positive immunohistopathological staining for prostate-specific antigen. The masses were diagnosed as metastatic adenocarcinoma of prostate gland origin. The patient died 3 months after the diagnosis of breast metastases. Autopsy revealed diffuse lymphogenous metastatic disease. Metastatic prostatic carcinoma to the breast is uncommon. Breast metastases in this patient might be associated with diffuse lymphogenous metastases as well as increased local blood and lymphatic supply caused by extrinsic estrogens.

We report a case of bilateral renal calculi in a 1-year-old female with adenine phosphoribosyl transferase (APRT) partial deficiency. She initially visited another institution with high fever as the major complaint. Computed tomography revealed a bilateral renal stone and left hydro nephrosis. In the urine, there were 2, 8-dihydroxyadenine (DHA) crystals. An analysis of the APRT gene revealed the APRT dificiency and the genotype to be APRT*J/APRT*Q0. We performed extracorporeal shock wave lithotripsy (ESWL) under general anesthesia, and as dissolution therapy we administered Meylon through the nephrostomy and citric acid orally. The stone disappeared from her kidney. The analysis of the stone fragments revealed 2,8- dihydroxyadenine (DHA) urolithiasis.

58歳糖尿病男性に発症したFournier's gangreneを経験した.早期診断にCTが有用であった.早期の外科的治療と抗菌剤の併用, ならびに血流改善を目的としたアルガトロバンの使用により, 良好な経過をたどり治癒した, A 58-year-old man was admitted to our hospital complaining of pain and marked swelling of scrotum and perineum. Physical and radiological examinations revealed gas-producing gangrenous changes involving the scrotum. Debridement was urgently carried out. Following the debridement under control of diabetes mellitus, antimicrobial agents and argatroban, a newly synthesized antithrombin medicine, were administered. Argatroban was used for the purpose of improving vascular insufficiency. Healthy granulation tissue was present five weeks later. Then surgical closure was carried out. Computed tomography was useful to make early diagnosis, and argatroban was thought to accelerate healing of the gangrene.