Giant prostatic hyperplasia is a rare condition characterized by very high volume benign prostatic enlargement (>500g). Few cases have been reported so far and most of them are associated with severe lower urinary symptoms. We report the first case of asymptomatic giant prostatic hyperplasia in an elderly man who had a 720g prostate adenoma, sudden gross hematuria and hypovolemic shock. The patient was successfully treated with open transvesical prostatectomy and had an uneventful postoperative recovery.

Retroperitoneoscopic adrenalectomy may be performed effectively and safely, with a low complication rate, independently of the etiology of the lesion. The lateral retroperitoneoscopic access is an excellent option for the minimally invasive treatment of the adrenal glands.

Laparoscopic adrenalectomy is a safe and efficient treatment for an adrenal mass of up to 10 cm. There are no relevant differences between the transperitoneal and retroperitoneal approach. Choice of the laparoscopic approach rests upon particular aspects of each case or upon the surgeon's preference.

The concept that extracorporeal shock wave lithotripsy (ESWL) may be used to successfully fragment urinary calculi in a noninvasive manner has revolutionized the management of urolithiasis.1 Complications of this procedure are usually limited to the kidneys and almost always resolve spontaneously.2 Whereas subcapsular renal hematomas have been present in up to 15% of patients in radiological studies, 3 hepatic hematomas have been reported only anecdotally and, to our knowledge, no case of infected hepatic hematoma has been previously described. The authors report a case of a patient who had an infected hepatic hematoma as a late complication of ESWL.A 35-year-old woman presented with a 1-year history of recurrent right renal colic and episodic macroscopic hematuria. The patient's medical history was unremarkable, and she was taking no medication. Physical examination disclosed an apparently healthy patient with no abnormality, with arterial blood pressure of 115/70 mm Hg. A plain radiograph of the abdomen, an ultrasound examination, and an excretory urogram (IVP) showed a 7-mm stone in the middle calices of the right kidney. Extracorporeal shock wave lithotripsy was then performed with a Dornier Compact-S lithotriptor requiring 5500 shocks at a potency of 6 (on a 1-9 scale). There was apparently no difficulty with stone fluoroscopic localization.Thereafter, the patient had 30 days of continuous pain in the flank and right upper quadrant. A plain radiograph of the abdomen disclosed a 4-mm stone in the pelvis of the right kidney. Ultrasound examination was not performed, as the stone was thought to be the cause of the pain. Extracorporeal shock wave lithotripsy was repeated under fluoroscopic guidance. The stone was completely fragmented with 2500 shocks at a potency of 6. In none of the ESWL procedures were antibiotics used, following the standard protocol of our service.Right upper quadrant pain persisted in the same fashion for 2 more consecutive months, now associated with occasional fever and weight loss (5 kg). Physical examination showed tenderness of the right upper quadrant of the abdomen. Hemoglobin was 12.2 g%, white blood cells 11800 mm 3 , urea 36 mg/dL, and creatinine 0.9 mg/dL. The urine culture was negative. Abdominal ultrasound revealed a 9.9 x 6.7 x 7.6-cm heterogenic mass in the inferior portion of the right hepatic lobe. All tumor markers for liver were negative. A computed tomography (CT) of the abdomen demonstrated a round, 6.0-cm diameter collection of fluid and air in the undersurface of the right hepatic lobe (Figure 1). A magnetic nuclear resonance (MRI) of the abdomen disclosed a 7.0-cm diameter homogeneous mass in the right hepatic lobe, suggestive of a hepatic abscess (Figure 2).The fluid collection was percutaneously drained, revealing 60 mL of brownish viscous fluid, suggesting a liquefied hematoma. Culture showed Klebsiella sp as an infecting organism. Fourteen days of third generation cepha- Figure 1 -Computed tomography image of the abdomen showing a gascontaining fluid collection...