Impalement injury to both the urinary bladder and the rectum is a rare occurrence. A 45-year-old man was referred to our hospital because he had been stabbed through the internal femoral skin by a steel bar. Retrograde cystography and computed tomography failed to demonstrate bladder rupture. We carried out cystoscopy (CS) because of the existence of gross hematuria and found a penetrating wound in the posterior wall. Colon fiberscopy revealed two wounds in the rectum, one of which communicated with the bladder. A diagnostic laparoscopy revealed no associated injuries in the peritoneal cavity. Vesicorectal injury was diagnosed and treatment included transanal closure of fistulas and indwelling ureteral and urethral catheters. Postoperative CS revealed complete closure of the injury.

A 63-year-old man with chronic renal failure who had received hemodialysis three times per week for 4 years developed neuroleptic malignant syndrome 10 days after taking amoxapine. His condition was characterized by muscle rigidity, elevation of body temperature and altered consciousness.Although he was treated with dantrolen and supportive care as well as discontinuation of amoxapine, his condition rapidly deteriorated, resulting in death. Because the pharmacokinetics of drugs, especially those such as antidepressants, in patients with chronic renal failure has not been fully clarified, one should be careful about giving such patients these drugs.

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Benign tumors of the renal pelvis are relatively rare, and only a few reports have been published so far. Recently we experienced a case of a 50-year-old woman with a fibroepithelial polyp in the left pelvis. Drip infusion pyelography and abdominal CT revealed a filling defect and tiny renal stones in the left pelvis under the study of her urinary blood occult. A transitional cell carcinoma of the renal pelvis was suspected, so a left total nephroureterectomy was done. The pathological diagnosis of this tumor was fibroepithelial polyp. As it is said that preoperative diagnosis of such a polyp is difficult, preoperative ureteroscopy or perioperative pathological diagnosis by frozen sections should be attempted. But it is difficult to avoid a nephroureterectomy because low incidence of the disease.