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65歳男.患者はPAS 19.09ng/mlで経直腸的前立腺針生検を施行し, 右葉2/3から中分化型腺癌が検出された.Neoadjuvant療法を開始し, 手術目的で入院となったが, 突然肝機能障害が出現して延期となった.そのためNeoadjuvant療法を継続し, 肝機能改善後, 恥骨後式前立腺全摘除術を施行した.しかし, 術後5日目に突然糞尿, 水様便が出現し, 膀胱尿道吻合部と直腸の交通が疑われた.術後13日目に膀胱尿道造影を施行したところ, 膀胱尿道吻合部から背側に造影剤の漏出を認め, それが瘻孔を通じて直腸まで流出していた.直腸尿道瘻と診断し, 保存的治療を試みたが奏功せず, 糞尿および水様便が持続するため, 術後56日目に経肛門的に瘻孔閉鎖術を施行した.閉鎖直後から糞尿, 水様便は消失し, 閉鎖15日目の膀胱尿道造影で瘻孔は造影されなかった.閉鎖術後2年経過現在, 瘻孔の再発は認められていない, A 65-year-old man underwent a radical retropubic prostatectomy for prostate cancer, and 5 days later fecaluria and serous diarrhea appeared suddenly. Cystourethrography domonstrated the flow of contrast material into the rectum through the fistula, so we diagnosed a rectourethral fistula. We first attempted conservative management, but the fistula did not close spontaneously. So we performed the transanal repair of rectourethral fistula about 2 months after surgery. This repair was effective, and the patient was alive without fistula recurrence at about 2 years after the repair surgery. This approach is simple and does not require a new incision, but it is only useful for low rectourethral fistulas.

We report a case of a large vesicourethral stone resulting from a long-term indwelling urethral catheter. A 66-year-old man visited our hospital emergency room on October 24, 2006 with a chief complaint of difficult urination. Although a urethral catheter was inserted temporarily based on the diagnosis of the doctor on duty, the patient did not return to our hospital for follow-up examination. On July 10, 2008, he was wheeled into our hospital with symptoms of general fatigue, urinary retention and post-renal failure due to urethral catheter obstruction. The catheter was undisturbed, and computed tomography revealed a large bladder stone that extended along the lines of the catheter. A cystostomy was established, and after renal function had recovered, the bladder stone was completely removed via laparotomy following the transurethral approach. The stone consisted of magnesium ammonium phosphate and calcium phosphate. It was concluded that the stone was closely related to a urinary tract infection caused by a Proteus strain. We discuss this unusual case, which is characterized by the stone size and the clinical course.

44歳女性。患者は人間ドックの腹部超音波検査にて左腎腫瘤を指摘され, 著者らの施設へ初診となった。臨床検査では異常所見はみられなかったものの, 腹部CTにて左腎中部に径6cmの腫瘤がみられ, 腎悪性腫瘍が疑われた。根治的左腎摘除術が施行された結果, 病理組織学的に腎原発のsolitary fibrous tumorと診断され, 現在は術後2年4ヵ月経過で再発および転移はみられていない。, The patient was a 44-year-old woman who had undergone a medical examination because of a left kidney mass. A radical nephrectomy was performed under diagnosis of renal cell carcinoma. Microscopically tumor consisted of spindle-shaped cells accompanied by fibrous connective tissue. Immunohistochemically the tumor cells were diffusely positive for CD34, negative for HMB45 antigen and tyrosinase. The final diagnosis was solitary fibrous tumor.

We report a case of a large vesicourethral stone resulting from a long-term indwelling urethral catheter. A 66-year-old man visited our hospital emergency room on October 24, 2006 with a chief complaint of difficult urination. Although a urethral catheter was inserted temporarily based on the diagnosis of the doctor on duty, the patient did not return to our hospital for follow-up examination. On July 10, 2008, he was wheeled into our hospital with symptoms of general fatigue, urinary retention and post-renal failure due to urethral catheter obstruction. The catheter was undisturbed, and computed tomography revealed a large bladder stone that extended along the lines of the catheter. A cystostomy was established, and after renal function had recovered, the bladder stone was completely removed via laparotomy following the transurethral approach. The stone consisted of magnesium ammonium phosphate and calcium phosphate. It was concluded that the stone was closely related to a urinary tract infection caused by a Proteus strain. We discuss this unusual case, which is characterized by the stone size and the clinical course.

The patient was a 44-year-old woman who had undergone a medical examination because of a left kidney mass. A radical nephrectomy was performed under diagnosis of renal cell carcinoma. Microscopically tumor consisted of spindle-shaped cells accompanied by fibrous connective tissue. Immunohistochemically the tumor cells were diffusely positive for CD34, negative for HMB45 antigen and tyrosinase. The final diagnosis was solitary fibrous tumor.

A 65-year-old man underwent a radical retropubic prostatectomy for prostate cancer, and 5 days later fecaluria and serous diarrhea appeared suddenly. Cystourethrography domonstrated the flow of contrast material into the rectum through the fistula, so we diagnosed a rectourethral fistula. We first attempted conservative management, but the fistula did not close spontaneously. So we performed the transanal repair of rectourethral fistula about 2 months after surgery. This repair was effective, and the patient was alive without fistula recurrence at about 2 years after the repair surgery. This approach is simple and does not require a new incision, but it is only useful for low rectourethral fistulas.