PURPOSE: We wanted to study the precise anatomical location of the branches of the pelvic plexus from the sacral root to the cavernous nerve. MATERIALS AND METHODS: We performed microdissection on the pelvises from 4 male formalin fixed cadavers under a Zeiss surgical microscope and we traced the location of the branches of the pelvic plexus at a magnification of 6x. RESULTS: The configuration of the pelvic plexus was an irregular diamond shape rather than rectangular. It was located retroperitoneally on the lateral wall of the rectum 8.2 to 11.5cm from the anal verge. Its midpoint was located 2.0 to 2.5cm from the seminal vesicle posterosuperiorly. A prominent neurovascular bundle (NVB) was located on the posterolateral portion of the apex and the mid portion of the prostate. The pelvic splanchnic nerve (PSN) joined the NVB at a point distal and inferior to the bladder-prostate (BP) junction. The PSN components joined the NVB in a spray-like distribution at multiple levels distal to the BP junction. The distance from the membranous urethra to the NVB was 0.5 to 1.2cm. We also found multiple tiny branches on the anterolateral aspect of the prostate apex. CONCLUSIONS: In contrast to the usual concept, the NVB was much wider above the mid portion of the prostrate and it supplied multiple tiny branches on the anterolateral aspect of the prostate. The PSN branches arose from the more posteroinferior area of the pelvic plexus. Therefore, we recommend a more anterior dissection of the lateral pelvic fascia for nerve sparing radical prostatectomy. If surgeons plan a nerve graft after radical prostatectomy, they should consider this neuroanatomy for obtaining a successful outcome.
Cadaver ; Diamond ; Fascia ; Formaldehyde ; Humans ; Hypogastric Plexus* ; Male ; Microdissection ; Neuroanatomy ; Pelvis ; Prostate ; Prostatectomy ; Rectum ; Seminal Vesicles ; Splanchnic Nerves ; Transplants ; Urethra

Small cell carcinoma was first described in the lung, and extrapulmonary small cell carcinoma has been reported at sites throughout the body. Small cell carcinoma of the genitourinary tract has more commonly been reported to arise from the urinary bladder. Small cell carcinoma of the kidney is extremely rare, rapidly progressive and lethal. Most of the reported cases have occurred in relatively old age people. We report here on a case of primary small cell carcinoma of the kidney in a young male, and this was managed via radical nephrectomy and cisplatin-based chemotherapy.
Carcinoma, Small Cell* ; Drug Therapy ; Humans ; Kidney* ; Lung ; Male* ; Nephrectomy ; Urinary Bladder

Sigmoidovesical fistula is a rare disease. Most of these patients have symptoms of chronic and recurrent urinary tract infection, pneumaturia and fecaluria. Furthermore, colorectal cancer with enterovesical fistula is very rare in the population. We have recently experienced a patient who had adenocarcinoma that originated colon along with sigmoidovesical fistula, and this was misdiagnosed as bladder cancer with urinary tract infection. We present here a case report of a 66-year-old woman who exhibited these diseases.
Adenocarcinoma ; Aged ; Colon ; Colorectal Neoplasms* ; Female ; Fistula* ; Humans ; Rare Diseases ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Tract Infections

STUDY DESIGN: This retrospective study is to confirm the diagnostic accuracy of percutaneous needle biopsy of vertebral lesions. OBJECTIVES: To evaluate the diagnostic accuracy of percutaneous needle biopsy and the clinical and pathological correlation of vertebral lesions. SUMMARY OF LITERATURE REVIEW: A review of previous articles showed that the diagnostic accuracy of percutaneous needle biopsy of vertebral lesions was between 77-94%. The greatest accuracy was achieved in diagnosis of metastatic disease or infection. MATERIALS AND METHODS: We performed 22 percutaneous needle biopsies in twenty vertebral bodies and two posterior elements under the CT guidance. All biopsies were performed with a 16-gauge Osty-cut bone biopsy needle. There were 1 cervical, 8 thoracic and 13 lumbar biopsies. Transpedicular approach was performed on 13 patients and paraspinal approach on 7 patients. There were 8 malignancies, 9 infections, 2 benign tumors, 2 compression fractures and 1 butterfly vertebra. RESULTS: An accurate diagnosis was made in 18 cases(81.8%) of all cases. Two of the 22 specimens were blood clots and two specimens of tuberculous spondylitis were insufficient for definite diagnosis. Bacteriological studies revealed a causative agent in 43% of pyogenic spondylitis. Histologic diagnosis confirming the clinical suspicion was obtained in 16(80%) of the 20 positive cases. There was no complication. CONCLUSION: Percutaneous needle biopsy under the CT guidance is a safe and accurate method for obtaining a diagnosis of vertebral lesions such as osteolytic lesion and infection.
Biopsy ; Biopsy, Needle* ; Butterflies ; Diagnosis ; Fractures, Compression ; Humans ; Needles* ; Retrospective Studies ; Spine ; Spondylitis

PURPOSE: Of all meniscal tears, isolated meniscal tear accounted for about 20%~30%. Also only a few reports in the literature dealt with isolated meniscal tear, which has a lower repairability and healing rate compared to patients with meniscal tear associated with ACL rupture. This study was undertaken to evaluate the clinical characteristics of isolated meniscal tear. MATERIALS AND METHODS: Between June, 1996 and May, 1999, 170 cases confirmed to have a meniscal tear by arthroscopy, were included in this study. We analysed clinical characteristics, according to the type of injury, medial meniscal tear versus lateral meniscal tear, type and site of meniscal tear, as well as possibility of repair. RESULTS: The frequency of medial meniscus tear is more common than that of lateral meniscus tear. Additionally, the most common cause of meniscal tear was non- contact injury. Of the total isolated meniscal tears, 20.5% were repaired. CONCLUSION: In our case, the incidence of medial meniscus tear is higher than that of the lateral meniscus tear, but this study noted a significantly low incidence of repairablity in isolated meniscal tear. Based on preliminary findings in this study, we consider degenerative change of meniscus as the most important factor explaining the clinical characteristics of meniscus tear in patients, especially, over the age of 30.
Arthroscopy ; Humans ; Incidence ; Menisci, Tibial ; Rupture

Since localized amyloid deposits of the ureter were first described by Lehmann in 1937, approximately 90 cases have been reported. Isolated primary amyloidosis of the ureter is a rare disease, and its diagnosis cannot be made by radiologic findings. Because of radiographic similarity to transitional cell carcinoma, these lesions are often clinically mistaken for malignancies, and nephroureterectomy is usually performed. Here, we report a case of localized ureteral amyloidosis with osseous metaplasia, which was managed successfully by renal sparing segmental resection with the bladder Boari flap.
Amyloidosis* ; Carcinoma, Transitional Cell ; Diagnosis ; Metaplasia* ; Plaque, Amyloid ; Rare Diseases ; Ureter* ; Urinary Bladder