Vesicoenteric fistula is a rare complication of bladder squamous cell carcinoma. We report the case of a 70-year-old male who complained of painless, total gross hematuria. Abdominopelvic computed tomography (CT) revealed an approximately 2.7-cm lobulated and contoured enhancing mass in the bladder dome. We performed partial cystectomy of the bladder dome after transurethral resection of the bladder. The biopsy result was bladder squamous cell carcinoma, with infiltrating serosa histopathologically, but the resection margin was free. Postoperatively, follow-up CT was done after 3 months. Follow-up CT revealed an approximately 4.7-cmx4.0-cm lobulated, contoured, and heterogeneous mass in the bladder dome. A vesicoenteric fistula was visible by cystography. Here we report this case of a vesicoenteric fistula due to bladder squamous cell carcinoma.
Aged ; Carcinoma, Squamous Cell/*complications/pathology/radiography ; Fatal Outcome ; Humans ; Intestinal Fistula/*etiology/radiography ; Male ; Sigmoid Diseases/*etiology/radiography ; Tomography, X-Ray Computed ; Urinary Bladder Fistula/*etiology/radiography ; Urinary Bladder Neoplasms/*complications/pathology/radiography

PURPOSE: It is well known that fungi become predominant microorganisms in the urine of patients with long-term Foley catheters. This study was conducted to evaluate the lengths of time for fungi to cause urinary tract infection (UTI) and to identify predictors of fungal UTI in burn patients with long-term Foley catheters. MATERIALS AND METHODS: A total of 93 patients who did not have infection at the time of admission but later had fugal UTI were evaluated. Urinalysis, urine culture, and Foley catheter indwelling were done at admission. All patients were administered prophylactic antibiotics from admission. Urine cultures were run every week, and catheters were changed every 2 weeks for each patient. RESULTS: Three of the 93 patients (3.2%) displayed fungal UTI at the 1st week of catheter indwelling. However, most patients (78.5%) displayed fungal UTI from 2nd to 5th week after catheter indwelling. The most prevalent fungus identified was Candida tropicalis (60.2%). By univariate logistic regression analysis, only the total body surface area burned (TBSAB) was predictive of fungal UTI in burn patients (p=0.010). By multivariate logistic regression analysis, underlying disease (p=0.032) and TBSAB (p=0.036) were predictors of fungal UTI. Patients with higher TBSAB were more likely to display shorter intervals from Foley catheterization to fungal UTI. CONCLUSIONS: Fungal UTI was initially found at the 1st week of urinary catheter indwelling, but the majority of cases occurred after the 1st week and appeared earlier in patients with underlying disease or higher TBSAB. Underlying disease and TBSAB were predictors of early fungal UTI.
Anti-Bacterial Agents ; Body Surface Area ; Burns ; Candida tropicalis ; Catheters ; Fungi ; Humans ; Logistic Models ; Urinalysis ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections

We report a case of nutcracker syndrome diagnosed with 3-dimensional computed tomography angiography (3-D CTA). Nutcracker syndrome had been confirmed by conventional venography until recent years. Nowadays, with the development of imaging techniques, color Doppler sonogram and 3-D CTA are replacing venography for the diagnosis of nutcracker syndrome. The patient, a 20-year-old male, had abrupt gross hematuria and left abdominal pain 6 months previously and intermittent microscopic hematuria thereafter. Including renal biopsy, the results of conventional hematuria study showed no abnormalities. 3-D CTA showed left renal vein compression between the abdominal aorta and superior mesenteric artery and collateral veins. The angle and distance between the superior mesenteric artery and aorta at the level of the left renal vein were 35degrees and 3.0 mm, respectively. We diagnosed nutcracker syndrome and later confirmed the diagnosis with venography.
Abdominal Pain ; Angiography ; Aorta ; Aorta, Abdominal ; Biopsy ; Hematuria ; Humans ; Male ; Mesenteric Artery, Superior ; Phlebography ; Renal Veins ; Veins ; Young Adult

PURPOSE: Endoscopic holmium:yttrium-aluminum-garnet (Ho:YAG) laser urethrotomy is an alternative method in the management of urethral strictures. We report our initial experience in 15 cases of evaluating the therapeutic efficacy of the holmium laser for treating incomplete urethral strictures. MATERIALS AND METHODS: Endoscopic holmium laser urethrotomy was primarily performed on 15 patients with incomplete urethral stricture. Exclusion criteria were complete urethral stricture and previous treatment of urethral stricture. Retrograde urethrography and uroflowmetry were performed preoperatively and were carried out as follow-up studies postoperatively. RESULTS: Successful results without recurrence were achieved in 8 of 15 patients. When we classified the results by stricture length, the success rate was 80% in strictures less than 2 cm, whereas there was no therapeutic effect in strictures over 2 cm. When we classified the results by etiology, the number of successful results in strictures with an inflammatory, trauma, iatrogenic, or unknown cause was 2 (2/8), 3 (3/4), 2 (2/2), and 1 (1/1), respectively. In 7 patients who failed treatment, we repeated holmium laser urethrotomy in 5 patients and urethroplasty in 2 patients. No operative complications occurred in any patients. CONCLUSIONS: Endoscopic holmium laser urethrotomy is a safe and effective minimally invasive therapeutic modality in cases of stricture less than 2 cm. Further data from long-term follow-up are necessary to compare the success rate with that of conventional urethrotomy and urethroplasty.
Constriction, Pathologic ; Follow-Up Studies ; Holmium ; Humans ; Lasers, Solid-State ; Recurrence ; Urethral Stricture

PURPOSE: There is a high prevalence of erectile dysfunction (ED) after electric injuries, but our medical understanding of ED after electric injuries is scanty at best. Thus, the authors attempted to investigate nocturnal penile tumescence (NPT), bulbocavernosus reflex latency (BCRL) and penile duplex Doppler ultrasonography (PDDU) for the patients who suffer from ED after electric injuries. MATERIALS AND METHODS: Of the patients who visited our Burn Care Center between January 2005 and February 2006, ten male patients (aged 20 or older) who complaining of ED after electric injuries underwent NPT, BCRL and PDDU. RESULTS: The patients' mean age was 38.1 years (age range: 25-54), and the numbers of patients exposed to whole body, upper-lower extremity and upper-upper extremity pathways of the electrical current were 1, 2 and 7, respectively. For the patient exposed to the whole body pathway, abnormal findings were observed on all the tests. For one patient who experienced two upper-lower extremity pathways, normal findings were seen on all the tests, while the other patient showed an abnormal NPT, an normal BCRL and an arteriogenic ED. Three of the patients who experienced the upper-upper extremity pathway showed normal findings on all the tests. The other two in the group showed an abnormal NPT, a normal BCRL and arteriogenic ED; the other one showed a normal vascular function, a abnormal NPT and no reaction to BCRL; the other one showed an abnormal NPT, a delayed BCRL and an arteriogenic ED. CONCLUSIONS: More abnormal findings were seen in NPT, BCRL and PDDU for the cases associated with upper-lower body or whole body electrical current pathways, as compared to patients whose electrical pathways were limited to the upper body.
Burns ; Electric Injuries* ; Erectile Dysfunction* ; Extremities ; Humans ; Male ; Penile Erection ; Prevalence ; Reflex ; Ultrasonography, Doppler, Duplex

PURPOSE: The severity of electrical injury depends on the intensity and pathway of the electric current. We hypothesized that erectile dysfunction (ED) may be a sequelae of electrical injury. Therefore, in this study, the prevalence of ED in electrical injury patients was estimated, and the results correlated with the electric voltage and pathway of the electric current at the time of the injury. MATERIALS AND METHODS: Mail and phone surveys were undertaken by 416 electrical injury patients admitted with electrical injury to our burn care center, between November, 1998 and December, 2003. Patients were given a self-administered questionnaire, which included the five item Korean version of the International Index of Erectile Function (IIEF-5). The voltage, pathway of electric current at the time of injury and other diseases, such as hypertension (HTN), diabetes mellitus (DM) and neurological disease, were also reviewed. Of the 416 (66%) subjects, 276 agreed to participate, but 20 (7%) of these were excluded due to HTN, DM and neurological disease. RESULTS: The remaining 256 patients constituted our patient population. The mean age was 39.2 (range 21 to 66) years. 52.7% of the 256 patients had ED. According to age, the prevalence of ED in patients in their third, forth, fifth and sixth decades were 43.8, 54.2, 55.8 and 42.9%, respectively; no patient in their seventh decade showed ED. There was no statistically significant difference among the age groups. 58.4, 21.2 and 33.3% patients with high, low and unknown voltage injuries had ED, which was statistically significant. The prevalence of ED according to the pathway of the electric current were 100, 70.3, 44.4, 31.9, 15.4 and 22.2% for whole body, upper-lower body, lower-lower body, upper-upper body, electrical spark burn and for unknown pathways, respectively. CONCLUSIONS: To our knowledge, this is the first study of ED in electrical injury patients. 52.7% of patients with electrical injury had ED. High voltage injures showed a higher prevalence of ED than low voltage injuries. Whole and upper-lower body pathways of the electric current showed a higher prevalence of ED compared to focal/local involvement (electrical spark burn), lower-lower body and upper-upper body pathways.
Burns ; Diabetes Mellitus ; Erectile Dysfunction* ; Humans ; Hypertension ; Male ; Postal Service ; Prevalence ; Surveys and Questionnaires

Dermatofibrosarcoma protuberans is an unusual locally aggressive cutaneous neoplasm of low grade malignancy. We report the case of a 47 years- old male who presented with an asymptomatic erythematous firm protruding mass in the left peri-inguinal area. Histopathologically, the tumor showed spindle-shape cells, arranged in a storiform pattern. The tumor cells stained positively for Vimentin and CD34 on immunohistochemical staining. Herein, we report a case of dermatofibrosarcoma protuberans.
Dermatofibrosarcoma* ; Humans ; Male ; Vimentin

PURPOSE: The urodynamic findings and subjective symptoms, in patients complaining of persistent lower urinary tract symptoms (LUTS) after a transurethral resection of the prostate (TURP) were evaluated. On the basis of these evaluations, the correlation, if any, between the urodynamic findings and the subjective symptoms was investigated. MATERIALS AND METHODS: A total of 47 men, with persistent voiding dysfunction more than a year following TURP, were evaluated using the international prostate symptom score (IPSS) and multichannel urodynamics. The patients were classified into three groups: obstructed (<10ml/sec), equivocal (10-15ml/sec) and unobstructed (>15ml/sec), according to their Abrams-Griffiths nomogram. RESULTS: From the urodynamic study, after the TURP, 6, 7 and 34 patients were placed into the obstructed, equivocal and unobstructed groups, respectively. There were no significant differences in the IPSS, and irritative and obstructive voiding symptom scores, between the obstructed, equivocal and unobstructed groups. The average IPSS in LUTS, with, and without, detrusor instability were 17.2+/-8.4 and 16.3+/-2.6 (p>0.05). The Qmax, detrusor pressure and residual urine volume, of the unobstructed group was significantly higher than those of the other two groups. CONCLUSIONS: Detrusor instability was the most frequent urodynamic finding in the patients complaining of persistent LUTS after TURP, but it is necessary to perform the urodynamics to decide on the appropriate treatment; either medical treatment, for the detrusor instability without a bladder outlet obstruction, or surgical removal of a bladder outlet obstruction. The symptoms were not reliable in predicting the urodynamic findings in regard to an obstruction and detrusor instability.
Humans ; Lower Urinary Tract Symptoms* ; Male ; Nomograms ; Prostate ; Prostatic Hyperplasia ; Transurethral Resection of Prostate* ; Urinary Bladder Neck Obstruction ; Urination Disorders ; Urodynamics

PURPOSE: Catheter-associated urinary tract infections are inevitable in patients with a long-term indwelling catheter. The antibacterial activity of nitrofurazone-impregnating compounds has recently been employed in urinary catheter, and may be effective in blocking infections. The aims of this study were to evaluate the bacterial isolation, antibiotic sensitivity test and the efficacy of a nitrofurazone-coated urinary catheter. MATERIALS AND METHODS: A total of 41 patients that required an indwelling urinary catheter for longer than 4 weeks were assigned to receive either a silicone (n=24), or nitrofurazone, coated catheter (n=17). Urine and catheter tip samples were cultured for bacteriological assessment. The results of the bacterial culture and antibiotic sensitivity test, rate of infection from urine and proximal tip were compared between the two groups. RESULTS: The bacterial cultures from the tips of the silicone and nitrofurazone catheters were in 95.8 and 82.4%, respectively, but were statistically insignificant (p=0.064). Bacteriuria developed in 79.2 and 64.7% of the silicone-coated and nitrofurazone-coated catheter groups (p=0.476). Gram negative bacteria were found in 65 (69.8%), with the most three frequent species being Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumonia in 23 (24.7%), 20 (21.5%) and 16 (17.2%), respectively. All the organisms were more susceptible to amikacin, aztreonam and ceftriaxone, but were relatively resistant to ampicillin, gentamycin and ciprofloxacin. CONCLUSIONS: Many of the patients with a long-term indwelling catheter had bacterial infections or colonization in the urine and proximal catheter-tip samples, despite the preventive administration of antibiotics. This study failed to demonstrate any efficacy of a nitrofurazone-coated catheter.
Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Aztreonam ; Bacterial Infections ; Bacteriuria ; Catheterization ; Catheters* ; Catheters, Indwelling ; Ceftriaxone ; Ciprofloxacin ; Colon ; Escherichia coli ; Gentamicins ; Gram-Negative Bacteria ; Humans ; Klebsiella ; Nitrofurazone ; Pneumonia ; Pseudomonas aeruginosa ; Silicones* ; Urinary Catheters ; Urinary Tract Infections

Intrauterine devices (IUD) can lead to several complications, including uterine perforation, ectopic pregnancy, spontaneous abortion and pelvic inflammatory disease, but these occur infrequently. The migration of an intrauterine device into the bladder, with the formation of a stone, occurs rarely. We report a case of a 45-year-old multiparous woman, with an egg sized and shaped bladder stone around an intrauterine device.
Abortion, Spontaneous ; Calculi ; Female ; Foreign Bodies ; Humans ; Intrauterine Devices* ; Middle Aged ; Ovum ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Ectopic ; Urinary Bladder Calculi* ; Urinary Bladder* ; Uterine Perforation