Hinyokika kiyo. Acta urologica Japonica
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Case Reports
[A case of bladder transitional cell carcinoma with sigmoidovesical fistula due to diverticulitis].
We present a case of bladder transitional cell carcinoma with sigmoidovesical fistula due to diverticulitis. The patient was a 65-year-old male who had been suffering from recurrent abdominal pain with high fever for the past 6 months. He noticed pneumaturia and cloudy urine several times. ⋯ Multiple diverticulosis of sigmoid colon was identified with barium enema examination. We performed transurethral resection of the bladder tumor. Three weeks later, the sigmoidovesical fistula was treated by primary resection of the sigmoid colon and wedge resection of the bladder including fistula.
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We treated 8 patients with bladder diverticula transurethrally. All four quadrants of the diverticular neck which acts as a sphincter and traps residual urine in the diverticulum was incised and the diverticular mucosa was fulgurated until the diverticulum was effaced. ⋯ Followup was incomplete in 3 cases. We found that transurethral incision and fulguration of the bladder diverticulum, in combination with transurethral treatment for the bladder outlet obstruction, is a safe, effective and less complicated method.
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Thirty three patients with benign prostatic hypertrophy (BPH) over age 80 who had undergone an open prostatectomy at our ward in the period of January of 1968-December of 1987 (20 years), were retrospectively studied for their complications before, during, or after the operation and prognosis. Preoperative complications were observed at a very high rate. When these complications may influence the prognosis, prudent care is required. ⋯ About 88% of the patients felt better post-operatively and had a good prognosis. In addition, there was no indication of the operation shortening their life. Consequently, an open prostatectomy was considered to be useful for elderly patients.
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Emphysematous cystitis is a rare but interesting disease. A case is reported of cystitis emphysema with acute pyelonephritis and uncontrolled diabetes. The patient was a 54-year-old woman complaining of gross hematuria and fever. ⋯ Radiography showed the gas around the bladder. The patient was administered antibiotics, then symptoms was improved. We reviewed 12 cases of emphysematous cystitis reported in Japan and summarized the pathophysiologic features of this entity.
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Using a Dornier HM3 lithotripter, we treated 1,000 patients with renal and ureteral stones from April, 1986 to July, 1989. They consisted of 612 solitary stones (pelvic stones, 152; calyceal stones, 167; ureteral stones, 293), 265 multiple stones and 123 staghorn calculi (complete, 48; partial, 75). The overall rate of the auxiliary procedure was 59.3% (pre-operative, 47.9%; post-operative, 11.4%). ⋯ Post-operative procedure included 69 transurethral lithotripsy , 21 PNSs, 26 percutaneous nephrolithotripsy (PNLs), 6 meatotomy , 5 chemolysis and 1 open surgery. 484 (68.3%) in 709 good follow-up cases were stone-free at the time of 3 months since the first extracorporeal shock-wave lithotripsy (ESWL). Complications were pain (34.8%), fever (4.3%), pain & fever (8.5%), subcapsular hematoma (0.1%) and ureteral obstruction (0.1%). Thus, ESWL is considered to be a useful means for renal and ureteral stones and in the case of large stone the combination therapy with PNL is more effective than ESWL-monotherapy.