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A 39-year-old man with macroscopic hematuria was admitted to our hospital. A stone, 5 mm in diameter was detected in the right ureteropelvic junction after abdominal computed tomography and plain abdominal radiography. We performed flexible transurethral lithotripsy (f-TUL) and crushed the stone and extracted almost all stone fragments without any complications. However, almost immediately after the operation, the patient began to complain about pain in the right back. In the results of abdominal plain computed tomography right renal subcapsular hematoma was detected. Because active bleeding was not observed in the results of enhanced computed tomography, only conservative treatment was performed. The patient was discharged from the hospital on day 11 of hospitalization. One month after the operation, plain computed tomography was performed and diminished subcapsular hematoma was detected. Renal subcapsular hematoma is assumed to be a unique complication of extracorporeal shock wave lithotripsy. This is the first report of a case of renal subcapsular hematoma caused by f-TUL. The onset of renal subcapsular hematoma following f-TUL could have been caused either because the laser fiber thrust into the renal lithiasis unintentionally or because the internal pressure of the renal pelvis increased substantially during the operation.

A 52-year-old man underwent distal gastrectomy for gastric cancer in November, 2007. In November, 2009, he visited our department with chief complaint of swelling of right intrascrotum andan inguinal mass. The tumor was suspected to be a primary tumor of the spermatic cord or metastasis of the gastric cancer. An operation was performed and histopathological examination revealedad enocarcinoma in the spermatic cord. Microscopic appearance of the surgical specimen of the right spermatic code demonstrated a CK7＋/ CK20− expression pattern, which is the same as that of past gastric cancer. These results suggested that the spermatic cord tumor was a metastatic lesion from the gastric cancer. The patient died 12 months later. Metastatic tumor of the spermatic cord resulting from gastric cancer is rare. We should take metastatic tumor into consideration the possibility of tumor of the spermatic code or tumor in the scrotum particularly when the patient has had an operation for cancer of the digestive system.

A 26-year-old man was introduced to our hospital with a complaint of macrohematuria. Endoscopic examination showed a small tumor in the anterior urethra. Microscopic examination of a biopsy specimen taken under lumbar anesthesia showed amyloid deposition in the urethral submucosa. On Congo red staining, amyloid was visualized as orange material, showing characteristic birefringence under polarized light. Amyloidosis of the urethra was diagnosed. Because the patient refused to undergo duodenal or rectal biopsy, the possibility of systemic amyloidosis could not be completely excluded. No recurrence has been noted since the endoscopic examination, and no further symptoms have been reported.

根治的膀胱全摘除術や動注化学放射線療法が施行できない浸潤性膀胱癌に対して, 白金製剤を用いた全身化学放射線併用療法を行い, 8例中6例のCRが得られ, 有害事象に関しても寛容であった, Eight patients with locally advanced bladder cancer who were not candidates for radical cystectomy or concurrent intra-arterial chemotherapy and radiotherapy were treated with combined platinum-based chemotherapy and radiation therapy. Six of the eight patients (75%) achieved a clinical complete response (CR). The effect of therapy in four patients whose histopathological responses were evaluated was effect grade 3. One of the eight patients died of treatment-related myelosuppression. The other two patients died of intercurrent disease, while the remaining five patients are alive with preservation of a functional bladder. The 2-year overall survival rate was 87.5%. Adverse events due to chemotherapy were mainly bone marrow suppression. Those caused by radiation therapy were rectal irritability. We considered concurrent platinum-based chemotherapy and radiotherapy useful for the treatment of locally advanced bladder cancer.

症例1(68歳男)は上咽頭癌の既往があり, 胃癌精査中に右腎下極に径20mm, 左腎中外側部に径20mmの腎癌を発見され, 胃部分切除と両側腎部分切除を行った.術後43ヵ月目に肺炎で死亡し, 腎癌の再発はなかった.症例2(53歳女)は右腎上極に径80mm, 左腎上極に径13mmの腎癌があり, 右腎摘出と左腎部分切除を行った.48ヵ月後迄は再発はない.症例3(48歳男)は右腎上極に径70mmと3個の径10mm, 左腎に4個の径10mmの腎癌があり, 右腎摘出と, 左腎部分切除を行った.23ヵ月後迄は再発はない, We report here three cases of bilateral synchronous renal cell carcinoma. One of the 3 patients underwent bilateral partial nephrectomy, while the other 2 underwent combined partial nephrectomy and radical nephrectomy. All patients received adjuvant therapy of interferon-alpha and tegafur uracil. In the management of synchronous bilateral renal cell carcinoma, we discussed the selection of surgical procedure for primary lesions, i.e., based on the renal function of both sides, and the necessity of adjuvant therapy in such cases.