Feng-Pin Chuang

Ketamine-associated bladder dysfunction

Objective:  To assess the impact of ketamine abuse on genitourinary tract dysfunction.

Renal Angiosarcoma- A Case Report And Literature Review

PURPOSE In adults renal cell carcinoma (RCC) accounts for over 85% of all diagnosed renal cancers. A much more rare and aggressive malignant tumor of the kidney is angiosarcoma (AS) with less than 25 cases described internationally. Both RCC and AS have similar radiological appearances and thus require histological evaluation for definitive diagnosis. We present a case of renal AS in a 63-year old male who was initially radiologically diagnosed as RCC, and review the current renal AS literature. METHODS The current English literature from 1981 and onwards on renal AS was reviewed and compared to our current case. RESULTS The median age and sex of patients with renal AS at presentation was 63 years old (mean 61 years) and common in males with a left kidney predominance. Symptoms included flank pain, palpable mass, and hematuria with imaging suggestive of RCC. Hematogenous metastatic spread often occurred with median survival time of 3.5 months from time of diagnosis (mean 5.8 months). Histologically, the tumors have classical features of angiosarcoma with numerous blood-filled vascular spaces lined by plump pleomorphic endothelial cells with CD31 and CD34 staining positivity. Overall treatment was radical nephrectomy with radiation therapy for local control and metastases. The use of chemotherapy was not consistent. CONCLUSION Although RCC accounts for the majority of malignant renal tumors, the poor prognosis of AS and its similar radiological appearance to RCC imparts the importance of histological evaluation and the potential radiological mimicry of AS.

Ipsilateral Synchronous Neoplasms of Kidney Presenting as Acute Pyelonephritis and Bladder Metastasis

Ipsilateral multiple synchronous primary renal neoplasms is an uncommon presentation, and only a few cases have been reported in published studies. We report the case of a 57-year-old woman with acute pyelonephritis as the initial presentation, in whom conservative treatment had no effect. Surgical intervention revealed the presence of concomitant renal cell carcinoma, collecting duct carcinoma, and urothelial carcinoma (transitional cell carcinoma) of the kidney. Metastatic renal cell carcinoma to the bladder, liver, and lung subsequently developed. Deceptive inflammatory presentations can occur in aggressive synchronous renal malignancies. Recognition of this rare disease entity could prevent delays in diagnosis and treatment.

Fibrosarcoma of the Kidney:A Case Report and Literature Review

Primary renal sarcomas of the kidney in adults are unusual, accounting for approximately 1% to 3% of all primary renal malignancies. Pathologically, leiomyosarcomas are the most frequent tumors of primary renal sarcomas, and fibrosarcomas of the kidney are rare. We report on a 46-yr-old male admitted to our hospital due to right side renal tumor. He received radical nephrectomy, and the histopathological report revealed primary fibrosarcoma of the right kidney. He received adjuvant radiotherapy with 5000 cGy due to invasion of the retroperitoneal muscle. Multiple organs metastases of lung, liver and bone developed 2 mo after nephrectomy. He died of the disease 6 mo after surgery. Prognoses of fibrosarcomas. Chemotherapy or radiotherapy is not helpful for survival. Herein, we present this case and review the literature.

Malignant Pelvic Paraganglioma with Bladder Invasion

We report a case of malignant pelvic paraganglioma invading the urinary bladder with malignant ascites. The computed tomography revealed a pelvic mass adjacent to the urinary bladder. The patient had hypertensive crisis while receiving cystoscopy for tumor evaluation. After thorough preoperative preparation, the patient underwent exploratory laparotomy with removal of pelvic tumor and partial cystectomy with reimplantation of right ureter. Malignant paraganglioma is not established upon the pathology, but upon local invasion to bladder and malignant cells in the ascites collected during the operation.

Fistula Involving Urinary Bladder: Experience with the Management of 23 Cases

PURPOSE: Fistula involving urinary bladder is a common disease caused by pelvic malignancies, radiotherapy, previous operations, primary intestinal diseases and trauma. We have reviewed our experience in diagnosis and management of 23 cases of fistulae involving urinary bladder. MATERIALS AND METHODS: From 1995 to 2000, 23 patients with fistulae involving urinary bladder were diagnosed and treated at eh Tri-Service General Hospital. Each patient’s record were reviewed retrospectively regarding symptoms, causes, primary disease processes, diagnostic studies, managements, complications, mortality and follow-up. RESULTS: The most common fistula involving urinary bladder was vesicointestinal fistula (57%), followed by vesicovaginal (26%) and vesicocutaneous (17%) fistulae. Fecaluria (46%) was the most common symptom of vesicointestinal fistula, while the major cause of vesicointestinal fistula was malignancy (54%). Urinary leakage from the vagina (100%) was a major symptom found in the patients of vesicovaginal fistula, which was caused by malignancy (33%), previous operation (33%) and radiotherapy (33%). Previous operation (75%) was found to be a major cause for vesicocutaneous fistula. Most of the fistulae involving urinary bladder may be diagnosed by cystoscopy (83%). The treatment and outcome were individualized, dependent on patient’s general condition and progression of the disease. CONCLUSIONS: The diagnosis of fistula involving urinary bladder can be established by combining the results of cystoscopy, colposcopy lower G-I series and cystography. Two-stage operation is preferable to single-stage operation in the case of vesicointestinal fistula, while a single-stage operation is recommended for the vesicovaginal and vesicocutaneous fistulae.

Transperineal Urethroplasty for Treatment of Traumatic Severe Stricture of the Urethra：Experience and Literature Review

OBJECTIVE: Transperineal urethroplasty is the treatment of choice for pelvic fractures with posterior urethral distractions, especially in cases of long-segment defect of the urethra or cases which are challenging to urologists. We present our experiences and long-term follow-up results. MATERIALS AND METHODS: From 1993 through 1999, eight patients with severe posterior urethral disruption due to pelvic fractures were treated at Tri-Service General Hospital (TSGH) in Taipei, Taiwan. All patients received including mechanism of injury, associated complications and secondary operative procedures was recorded. Recurrence was determined using cystoscopy or retrograde urethrography and long-term voiding functions were determined using residual urine and uroflowmetry. Sexual functions were also determined using apatient questionnaire. RESULTS: The mean age was 29.4 years (range 23-50 years). The mean interval between suprapubic cystostomy and transperineal urethroplasty was 5.6 months (range 4-9 months). The mean urethral stricture length was 2.8 cm (range 1.5-7 cm). During the follow-up period (range 17-73 months; mean 45.8), the overall postoperative re-stricture rate was 75% (6/8); 15 visual internal urethrotomies and 20 urethral dilations with sounds were performed subsequently. All eight patients now have patent urethras, and seven (87.5%) void well and are continent except one who has an underactive neurogenic bladder secondary to the injury. Erectile dysfunction (ED) was present both preoperatively and postoperatively in four (50%) of the patients. Of these, three had urethral re-stricture postoperatively. CONCLUSIONS: In our experience, the principal problem was re-stricturing which can usually can be treated by secondary urethrotomy or dilation. Re-stricture of the urethra was easily noted in severely injured urethras. There were no changes in ED before or after operations. The long-term postoperative follow-up of voiding and sexual functions is mandatory.

Growing Teratoma Syndrome:A Case Report

Growing teratoma syndrome refers to retroperitoneal or other metastatic masses containing mature teratoma enlarging during chemotherapy for nonseminomatous germ cell tumors. Surgery is often difficult and early exploration optimizes the chance of resection which is necessary for long term survival. A case of the growing teratoma syndrome with metastatic masses in the retroperitoneum, lung and neck is presented. This patient was treated with surgery and systemic chemotherapy. Unfortunately, the patient died of respiratory failure due to huge metastatic tumor in the right intrathoracic cavity. Had the surgery been performed earlier, the patient could most likely have survived. Therefore, in cases of growing teratoma syndrome, surgical removal of the tumor should be done as early as possible.