Kawano M

LEFT ACUTE SCROTUM ASSOCIATED WITH APPENDICITIS

A 10‐year‐old boy, who had a mild inguinal hernia in his left scrotum, was referred to our clinic because of redness of the scrotal skin and tenderness of the left scrotal contents. Scrotal echography showed a hypoechoic lesion around the normal testis and epididymis. Because torsion of either the testis or testicular appendage was suspected, the scrotum was opened and 1.5 mLof purulent fluid was observed in the tunica vaginalis with inflammatory tissue around the testis and epididymis. On the first postoperative day, a low grade fever and abdominal tenderness persisted, however, the abdomen was flat and soft. There was no marked tenderness over McBurneys point, butthere was moderate tenderness over Lanzs point on deep palpation. Abdominal sonography and magnetic resonance imaging revealed abscess formation between the bladder and the sacrum. With a diagnosis of perforation of the appendix, a laparotomy was performed. The inguinal hernia sac could not be observed on inspection, and it was not possible to palpate the left side because of severe adhesion due to infection. Also, the neck of the right inguinal sac could not be seen. The appendix specimen was gangrenous. On the second postsurgical day, all symptoms and signs disappeared. We present this rare condition and discuss the difficulty in establishing a diagnosis.

Is a cystic lesion located at the midline of the prostate a müllerian duct cyst? Analysis of aspirated fluid and histopathological study of the cyst wall.

OBJECTIVE In 6 patients, ranging in age from 26 to 71 years, we analyzed aspirated fluid and histologically studied cystic lesions located at the midline of the prostate. METHODS Digital rectal examination, ultrasonography, magnetic resonance imaging, and aspiration of cystic fluid were performed to evaluate size, contents, and location of the cystic lesion. A 22-gauge needle was inserted into the cystic lesion perineally under ultrasound guidance. After extracting fluid for cytology and measurement of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP), a specimen from the prostate involving the cystic wall was collected. Hematoxylin-eosin staining and immunohistochemical staining for PSA were performed. RESULTS All aspirated fluid specimens were yellowish and clear without any sperm or malignant cells. The PSA levels in the fluid ranged between 90 and 670 x 10(4) ng/ml, while the PAP levels were between 168 and 4,000 ng/ml. These levels of PSA and PAP were significantly higher as compared with those in the serum. The cystic wall was lined with cuboidal or columnar epithelium. Some epithelial cells from the cystic wall showed positive immunostaining for PSA. CONCLUSIONS Not all cystic lesions located at the midline of the prostate are müllerian duct cysts, and there is a high probability that the lesion could be a cystadenoma or a simple cyst of the prostate.

Epidermoid cyst arising from the spermatic cord area

Purpose : We report on an epidermoid cyst arising from the spermatic cord area that was confirmed histologically after local excision.

Subcapsular orchiectomy using ultrasonic surgical aspirator for testicular androgen ablation: A new alternative technique and long-term follow-up

SummaryWe report results in 12 patients obtained using a technique of subcapsular orchiectomy with an ultrasonic surgical aspirator (CUSA) and the changes in serum testosterone level after orchiectomy. The procedure was simple and safe, and the time for the operation ranged from 38 min to 65 min, taking an average of 46 min. The average time for aspiration of each testis was 15 min. Operative complications, such as bleeding, post-operative pain and wound-swelling were minimal and compression dressings were not necessary. Post-operatively, the serum testosterone level dropped to within a castrated level and remained at this level for 5 years. We concluded that subcapsular orchiectomy using CUSA is superior to conventional bilateral scrotal orchiectomy and will be a useful option for testicular androgen ablation.

Ethanol embolization for impotent patients with venous leakage: A new technique and initial results

SummaryFor the purpose of the complete interception of venous drainage, ethanol embolization via the deep dorsal vein of the penis was performed in seven impotent patients with venous leakage. Two ml of 25% ethanol and/or 2 ml of 50% ethanol were slowly injected under fluorescence control. If embolization was performed incompletely with the initial dose of ethanol, 2 ml of 99.5% ethanol was reinjected. Erectile dysfunction improved in all of them. This condition continued for 6–12 months. Within follow up, no major adverse reaction was noted. In conclusion, it is considered that this technique is useful for management of venous drainage and long-term follow up will be necessary.