Background. Malignant melanoma is one of the rarest tumors of the female urethra. The prognosis of urethral melanoma is poor. Methods. A 59‐year‐old woman underwent total urethrectomy, bilateral inguinal lymph node dissection, and vesicostomy for Stage A primary malignant melanoma of the urethra. She received adjuvant therapy consisting of dacarbazine, vincristine, cyclophosphamide, and alpha‐interferon. Two years later, repair of the parastomal hernia and interposition of an isoperistaltically ileum intussusception between the bladder and the abdominal wall were done. Results. Complete continence was achieved, and the patient catheterizes herself every 3–5 hours during the day and once at night without difficulty. She has survived 5 years without any evidence of tumor recurrence. Conclusions. There have been only six case reports of women with primary malignant melanoma of the urethra surviving more than 5 years, including this case. Total urethrectomy with bilateral inguinal lymph node dissection should be done as the initial form of the treatment in patients with this disease who have no evidence of distant metastasis. The postoperative adjuvant therapy, consisting of alpha‐interferon and chemotherapy, should be administered immediately; therefore, vesicostomy was done because it is a simple procedure. However, this type of urinary diversion requires an external appliance. Clinicians should consider the patient's quality of life, prognosis, and general condition and attempt to solve the problems of patients 2–3 years after the operation.
The viability and location of bacteria within infection stones were investigated. Many stones were infected with urea-splitting bacteria, such as Proteus mirabilis and Pseudomonas aeruginosa. Large numbers of bacterial impressions and bodies were found in the interstices surrounded by crystals of apatite and struvite from the nuclei to the peripheral layers. The presence of bacterial colonies even in the nuclear portion of the stones suggests that bacteria participate in the initial stone formation as well as in growth of infection stones. Streptococcus faecalis, a nonurea -splitting bacteria, also was found in some infection stones and probably represents a superimposed infection as a result of changes in bacterial flora owing to treatment with antibiotics.
We report a 2 year-old boy with Menkes' kinky hair disease associated with a solitary huge bladder diverticulum. To our knowledge this is the first reported case treated successfully by surgical excision under general anesthesia, which has been previously considered hazardous due to the poor general condition of the patient.
The value of autotransfusion is widely recognized in the surgical community and may be of increasing importance in prevention of acquired immunodeficiency syndrome and hepatitis. The concern of possible contamination of the blood with urine, bacteria in urine or viable tumor cells has limited the wide use of intraoperative autotransfusion (IAT) in urological operation. There have been no experimental reports about protection of the blood from such contamination. To investigate separation of the blood from a contaminated mixture by using an autotransfusion machine, Haemonetic Cell Saver, a study composed of three experiments was performed. First, 200 ml of blood was mixed 200 ml of urine, and thereafter, the mixture was processed by the machine and the concentration erythrocytes were collected in a bag. Biochemical analysis of the collected erythrocyte solution (CES) was performed. Second, 200 ml of blood was mixed with 200 ml of urine that was adjusted to contain each 10(7)/ml of four bacterial strains. The bacteriological study of the CES was performed. Third, 200 ml of blood was mixed with 200 ml of urine that was adjusted to contain 10(7) cancer cells. Two cell lines, KK47 originated from human bladder cancer and ACHN originated from human renal cell carcinoma was used. The cytological study of the CES was performed. The results of these experiments were: Urine constituents were completely removed from the mixture. However, all strains of bacteria could not be separated, although the number of bacteria decreased. Cancer cells were found in the CES. In conclusion IAT should be done at urological operation in selected patients that have sterile urine and do not have tumor cells in the operation field.
We report a case of adenocarcinoma of the augmented bladder 19 years after ileocystolasty. The patient was a 53-year-old man who underwent right nephrectomy and ileocystoplasty (Pyrah's method) for contracted bladder due to tuberculosis in 1965. In another hospital, transurethral resection (TUR) was performed against a tumor in the anastomotic site between the bladder and the ileal segment in 1996. Histopathological examination of the specimen obtained by TUR revealed poorly-differentiated mucinous adenocarcinoma. In our hospital, partial cystectomy with total resection of ileal segment and ileocystoplasty were performed. The tumors located in the anastomotic site between the bladder and ileal segment as well as in the ileal segment. Histopathological examination revealed poorly-differentiated mucinous adenocarcinoma. The patient has survived 12 months without any evidence of tumor recurrence. To our knowledge, this is the eighth case report in Japan.
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