(Purpose) Microsurgical varicocelectomy procedures are known to have high rates of success and minimal incidence of postoperative hydrocele occurrences in adults. Herein, we report our initial experience with microsurgical inguinal and subinguinal techniques for the treatment of varicoceles in adolescent patients. (Patients and methods) A total of 9 boys (averaged age 12.7 years each younger than 15 at the time of the operation) with a left varicocele underwent microsurgical inguinal or subinguinal repair, and were included in this study. (Results) The microsurgical varicocelectomy procedures including meticulous dissection required a mean 170.4±45.6 minutes (range, 105-240 minutes) and the testicular arteries were preserved in all patients. Catch-up growth was seen in one of two patients whose testicular volumes were determined by ultrasonography both pre and post operatively. None of the patients has developed a recurrent varicocele or postoperative hydrocele after a mean follow-up of 24.6 months. (Conclusion) As with adults, microsurgical subinguinal and inguinal varicocelectomy procedures are safe and effective, and can be considered one of feasible treatment for varicoceles in adolescents.
(Objectives) We investigated a clinical features and outcomes of prostate cancer detected in Tone Central Hospital. (Materials and methods) We investigated clinical features of 532 patients with pathologically confirmed prostate cancer detected in our hospital between 1987 and 2006. Furthermore, we compared survival rates of screen detected prostate cancer (SC group) with those of non-screen detected prostate cancer (NSC group) for 362 cases diagnosed with prostate cancer after 1999. 362 cases consist of 223 patients in SC group and 139 patients in NSC group. (Results) Since 1987, the annual number of newly diagnosed patients has gradually increased and we recognized stage migration, a tendency toward an annual decrease in the incidence of stages A and D and an increase in that of stage B. The stage distributions of SC group (223 cases) and NSC group (139 cases), respectively, were 0.4% (1/223) and 9.4% (13/139) in stage A (p=0.0011), 71.3% (159/223) and 31.7% (44/139) in stage B (p< 0.0001), 24.2% (54/223) and 23.7% (33/139) in stage C (p=0.9182), and 4.0% (9/223) and 34.6% (46/223) in stage D (p< 0.0001). The 3, 5 and 7-year overall survival rates, respectively, were 95.6%, 92.7% and 84.1% in SC group, and 83.2%, 74.3% and 60.8% in NSC group (p< 0.0001). Furthermore, the 3, 5 and 7-year cause-specific survival rates, respectively, were 98.8%, 97.3% and 95.9% in SC group, and 90.2%, 87.7% and 79.4% in NSC group (p< 0.0001). (Conclusions) Clinical stage distribution has been changed between 1987 and 2006. Furthermore, overall and cause specific survival rates were better in screen detected prostate cancer than non-screen detected prostate cancer, because of increases in earlier stage of prostate cancer in SC group.
A 41 year-old man with a history of diabetes mellitus underwent computed tomography for screening on August 2007. The CT revealed an enhancing 3.0 cm mass in the middle pole of the left kidney. We diagnosed as renal cancer, clinical stage T1aN0M0. Then he underwent laparoscopic left partial nephrectomy. The pathological result was renal cell carcinoma, G2> G1, pT1a. On post operative day 12, he appeared a gross hematuria and dysuria, then he was rehospitalized due to drop of hemogrobin and bladder tamponade. Enhanced CT showed left renal artery pseudoaneurysm. He underwent selective coil embolization of left renal artery pseudoaneurysm. After that he repeated gross hematuria, and appeared bladder tamponade again. On POD 65 he underwent selective coil embolization again. Since then the patient recovered uneventfully.
A 76-year-old woman with right renal pelvic cancer underwent a laparoscopic nephroureterectomy via a retroperitoneal approach. During the 300 minutes of CO2 insufflation, arterial blood pressure, temperature, and oxygen saturation were stable, whereas the end-tidal CO2 (ETCO2) gradually increased and reached a peak of 55 mmHg. Her arterial blood gas analysis suggested acute respiratory acidosis. She developed hypercapnia inspite of controlled hyperventilation in response to the increasing ETCO2. Skin crepitus was extending into the neck and face from the operative site. A portable chest radiograph taken postoperatively showed pneumomediastinum and extensive subcutaneous emphysema of neck and chest wall. Laryngoscopy revealed grossly emphysematous pharyngeal tissues preventing direct vocal cord visualization. Her airway was appeared to be totally occluded by markedly edematous laryngeal tissues. As a leak sound around the tracheal tube was not heard after deflation of the tube cuff, her pharyngeal swelling was suspected to be severe and tracheal extubation during the operation was postponed. When cervicofacial emphysema occurs intraoperatively, we recommend that laryngoscopy should be performed before tracheal extubation to avoid potential airway obstruction from associated pharyngeal emphysema.
The patient was a 34-year-old man presenting with the right intra-scrotal painless mass. With a diagnosis of right intrascrotal tumor, the patient underwent right high orchiectomy. The pathological diagnosis of pleomorphic rhabdomyosarcoma arisen from the right spermatic cord was made. Computed tomography revealed a single metastasis in the para-vena cava lymph node. Systemic chemotherapy with vincristine, actinomycin D, plus cyclophosphamide (VAC therapy), and etoposide plus cisplatin (EP therapy) were made according to Intergroup Rhabdomyosarcoma Study (IRS) -IV Regimen 45. But the chemotherapy was ineffective and a retoroperitoneal lymphadenectomy (RPLND) was therefore performed. After 3 months following RPLND, the tumor relapsed in a pelvic lymph node involved in right ureter and ileocaecal valve. Resection of the tumor with ileocaecum was performed and then intraoperative radiotherapy (15 Gy) against the tumor bed was performed to ensure the curative effects. After his recovery, he received a total of 6 courses of systemic chemotherapy consisting of vincristin, ifosphamide, etoposide (IRS-IV Regimen 47). The patient was rigorously followed up for 42 months after the final chemotherapy, with no tumor recurrence.
A 66-year-old man visited his nearby clinic with a complaint of left lower abdominal pain. Abdominal CT scan showed left hydronephrosis due to lower ureteral involvement by infiltrative retroperitoneal mass located outside of the left posterior wall of the bladder and left seminal vesicle. He was referred to our hospital for further examination. Pathological diagnosis of the percutaneous CT-guided biopsy of retroperitoneal mass was fibrosis without any malignant tumor. Because we could not rule out the possibility of the secondary fibrosis accompanied by malignant tumor, we performed surgical resection of the retroperitoneal mass involving left ureter and confirmed that the mass contains no malignant tumor by frozen section analysis. We augmented the defected ureter by Boari flap method. We should be noticed that retroperitoneal fibrosis could be a differential diagnosis of retroperitoneal pelvic mass.