(Purpose) I observed bladder and urethral morphology and lumen by making a virtual endoscopy (VE) of the bladder and a urethra for patients with lower urinary tract symptoms. I have herein reported the procedures to use this model to evaluate the condition of patients more precisely. (Patients and methods) Of those referred for investigation of lower urinary tract symptoms, subjects were 22 boys (5-13 years old, mean 9) in whom voiding cystourethrography (VCUG) was suspected for urethral obstruction between March, 2009 and October, 2010. Eleven of these 22 cases were extracted at random and underwent voiding computed tomography (VCT). Except one dropped out, the 21 cases were assigned to a VCT/VCUG combination group or a VCUG-single group. We confirmed the two groups, the rate of agreement of imaging views and cystourethroscopy (CS) views, and the effectiveness of endoscopic operation. (Result) I made the following imaging diagnoses in the VCT/VCUG combination group: congenital obstructive posterior urethral membrane (COPUM), n=7; Cobb's collar, n=1; and COPUM and Cobb's collar combined, n=3. In contrast, in the VCUG-single group, I diagnosed COPUM, n=5; bulbar region urethral stricture, n=2; posterior urethral expansion, n=2; and bladder form abnormality, n=1. The rate of agreement between preoperative diagnosis and CS views on imaging was 72.7% in the VCT/VCUG combination group, and 33.3% in the VCUG-single group. All patients underwent transurethral incision (TUI) of the urethral obstruction. In the VCT/VCUG combination group, effectiveness of the TUI was assessed as good in 2 cases and moderate in 6 cases giving an overall effectiveness rate (good+moderate) of 72.7%. In the VCUG-single group, effectiveness was rated as moderate in 5 cases (overall effectiveness rate=50%). (Conclusion) I developed a method of VE for lower urinary tract obstruction of children and examined the effectiveness. This method was found to be more effective than conventional urinary tract imaging. With the developments in the equipment, this method may in future be useful as an adjunct to CS and urodynamic studies.

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(Purpose) Nephron-sparing surgery for small renal tumors has gained acceptance in an attempt to preserve renal function while achieving a level of cancer control equivalent to that obtained by radical nephrectomy. Moreover, laparoscopic partial nephrectomy (LPN) has been applied to partial nephrectomy because of it is less invasive. However, LPN is a technically complex procedure and has more potential for complications than open partial nephrectomy (OPN). Using hemostatic agents is one of the options to avoid complications during LPN. Microporous polysaccharide hemispheres (MPH) are an absorbable hemostatic powder produced from purified potato starch. We compare the efficacy of this new hemostatic agent, MPH and the standard hemostatic agent, fibrin glue. (Methods) Between January 2007 and March 2011, 55 LPNs for suspected malignancy were completed by a single surgeon in Yokohama City University Hospital. We compare two sequential groups of patients: group A consisted of 12 patients in whom MPH was used (age 41-77, mean age 59.7, male: female=10 : 2) and group B consisted of 43 patients in whom fibrin glue was used (age 22-79, mean age 60.3, male: female=31 : 12), retrospectively. These agents (MPH and fibrin glue) were applied to the partial nephrectomy bed before tying a suture in parenchymal suturing and after the renal hilum was unclamped. (Results) The MPH group showed significantly less mean estimated blood loss (25.6 vs. 86.3 ml; p=0.036). There was no significant difference in surgical duration, ischemic time or urine leakage. Postoperative complications occurred in two patients in group B, but there were no postoperative complications in group A. (Conclusions) MPH is available as an adequate hemostatic agent during LPN. There was no significant difference in the incidence of postoperative complications between MPH and fibrin glue.

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We report a case of ruptured renal artery aneurysm into the renal pelvis. A 48-year-old woman presented with complaints of gross hematuria and right back pain. Abdominal ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) revealed the aneurysm, which was 5×5 cm in diameter. Enhansed CT revealed blood flow from the renal artery aneurysm into the renal pelvis. Radical nephrectomy was performed. Rupture of renal artery aneurysm into the renal pelvis is the 3rd case in the Japanese literatures. Pathogenesis and management of this rare condition are discussed.

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A 76-year-old man underwent high orchiectomy due to a painless tumor in the left inguinal region. Pathological diagnosis was malignant fibrous histiocytoma (MFH) of the left spermatic cord. Because of positive surgical margins, additional resection of the left scrotal wall and left inguinal canal combined with retroperitoneal lymphadenectomy were performed, with the surgical margins negative. Adjuvant therapy was not administered.Eight years later he noticed a painful subcutaneous mass in the left inguinal region. CT showed local recurrence and metastases of MFH to mesenteric lymph nodes and the left adrenal gland. The tumor grew rapidly and the patient died 1 month after admission. Autopsy revealed local recurrence of MFH and metastases of MFH to liver, lung, left adrenal gland, bone and lymph nodes. Recurrence of MFH with an interval of 8 years is a rare event.

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Wound necrosis and groin lymphorrhea after inguinal lymph nodes dissection are serious complications. But treatment options for these complications are somewhat controversial. We report a patient who underwent an inguinal lymph node dissection for a regional metastasized squamous cell carcinoma of penis. Unfortunately, a extensive wound necrosis occurred with lymphorrhea (300 cc daily). After operative debridement, negative pressure wound therapy was started. We had used the instrument " V.A.C. (Vacuum Assisted Closure) ATS^® Therapy System" (KCI U.S.A.). After 11 days of negative pressure wound therapy, the good formation granulation tissue was observed and the lymphatic leakage was prominently decreased. This therapy was performed without serious complications but tolerable localized pain due to negative pressure. There were only seven reports that gave the description of an approach using negative pressure wound therapy for the less invasive treatment of lymphocutaneous fistulas and evaluated the efficacy of this therapy as an alternative medical procedure for treating lymphorrhea. This case suggested that negative pressure wound therapy could not only promote wound healing but also improve intractable lymphorrhea.

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