Unusual cause of hematuria

The leech is an invertebrate which has the habit of entering the anatomical orifices of man and animals. During the process of sucking blood it releases an anticoagulant and causes continuous bleeding from the bite site. A leech as a cause of gross hematuria is unusual. We present a case of a leech in the bladder as a cause of gross hematuria.     

Ureteral stump carcinoma incidentally found at cystectomy for bladder cancer

We report on a sixty-five-year-old man with hematuria secondary to superficial bladder cancer. Because of previous urethral trauma, a complete transurethral resection of his bladder tumor could not be done. He, therefore, underwent cystectomy, at which time we incidentally found a transitional cell carcinoma of the left ureteral stump that had been left from a previous left nephrectomy for a World War II-related injury. This case underscores the importance of a thorough investigation of the complete urinary tract in a patient with hematuria or other urinary tract symptoms even if an obvious cause is found for his symptoms.     

Hematuria as the presenting symptom of a metastatic thyroid cancer

A 67-year-old man is presented who was admitted to our hospital for the onset of hematuria and acute urinary retention and who was found to have a 10-cm solid mass in the right obturator fossa compressing the bladder wall. Histology revealed the presence of a distant metastases from thyroid cancer. To the best of our knowledge, this is the first case of a thyroid cancer presenting with hematuria and acute urinary retention caused by distant metastases to intrapelvic soft tissue.     

Prostatic cystadenoma presenting as a large multilocular mass

A case is reported here of a patient with a giant multilocular prostatic cystadenoma who presented with gross hematuria and underwent extensive surgical resection. A 35-year-old man presented with asymptomatic gross hematuria. Magnetic resonance imaging of the pelvis demonstrated a multilocular mass replacing the prostatic gland. At exploration the urinary bladder was found to be displaced anterolaterally and severely adherent to the large tumor. The pathological features were consistent with multilocular prostatic cystadenoma. There have been no signs of tumor recurrence during 24 months' follow-up after surgery. Although the natural history of prostatic cystadenoma remains unknown, complete surgical excision may not always be necessary. Physicians should at least be aware of the possibility of this disease entity before making treatment decisions.     

Stage pT1 signet ring cell carcinoma of the urinary bladder: a case report

A case of primary signet ring cell carcinoma of the urinary bladder is described. A 59-year-old man presented with microscopic hematuria, and cystoscopy revealed a white nonpapillary tumor. Histopathological examination of the resected tumor revealed signet ring cell carcinoma and transitional cell carcinoma. Histological depth of invasion was pT1. No adjuvant therapy was performed. Primary signet ring cell of the urinary bladder is a rare tumor with 37 cases reported to date in Japan. We investigated previously reported cases and discussed adjuvant therapies of superficial signet ring cell carcinoma of the urinary bladder.     

Chronic painless hematuria and urethral bleeding as the presenting manifestations of Osler-Weber-Rendu disease.

A case of a young man with profound iron deficiency anemia, chronic painless hematuria and urethral bleeding is presented. He had the typical cutaneous findings of Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia). Appropriate urological studies demonstrated bladder and urethral telangiectases, with no other explanation for the bleeding. Osler-Weber-Rendu disease should be considered in the differential diagnosis of chronic painless hematuria.     

Primary undifferentiated carcinoma of the ureteral stump; a case report

A 72-year-old man referred our hospital with the chief complaint of macroscopic hematuria. He had undergone simple left nephrectomy for left renal stone when he was 27-years-old. His urine cytology showed class IIIb. They were 4 times. We performed random biopsy of the bladder and retrograde pyelography of the right But they were no positive findings for the cause of hematuria and for the existence of malignancy. After 2 months, he had macroscopic hematuria again. Cystoscopic re-examination revealed a fibrin out of the residual left ureteral orifice. Computed tomographic scan showed a perivesical mass. The diagnosis was the carcinoma of the ureteral stump. We performed ureterectomy. The pathological study revealed the undifferentiated carcinoma. This case is the first report of the undifferentiated carcinoma occurred on the residual ureteral stump in the Japanese literature.     

Castleman disease in the pelvic retroperitoneum

About 50% of the cases with Castleman disease firstly described by Castleman in 1956 occur in the thoracic cavity. The pelvic cavity is a rare location affected by the disease; there are only 7 reports. Herein, a case of Castleman disease of the pelvic cavity is reported. A 41-year-old man complaining of microscopic hematuria consulted us. Drip intravenous pyelography and computerized tomography showed a solitary mass at the pelvic retroperitoneum. Abnormal laboratory findings were as follows; glucose tolerance test (GTT), erythrocyte sedimentation rate, alpha 2-globulin level, CRP titer and hematuria. With the diagnosis of a pelvic retroperitoneal tumor, pelvic exploration was performed. The resected tumor was encapsulated, elastic hard and 4x3x2 cm in size. The cut surface was homogeneously granular and yellowish white in color. Histological diagnosis was the plasma cell type of Castleman disease. Within three weeks after the operation, laboratory abnormalities diminished except for GTT and microscopic hematuria. The patient is free from the disease with no signs of recurrence for 2 years postoperatively.     

Massive hematuria after cystoscopy in a patient with an internal iliac artery aneurysm.

An unusual case is reported here of a patient with internal iliac artery aneurysm who developed massive hematuria after cystoscopic examination. A 75-year-old man presented with asymptomatic gross hematuria. Cystoscopic examination revealed that the bladder neck was congested and that the right-side wall was being pressed on by an extrinsic mass. Computed tomography showed a right internal iliac artery aneurysm and tortuous perivesical vessels. Three days after the cystoscopic examination the patient suffered massive hematuria. Hemorrhage due to an arteriovesical or arterio-ureteral fistula secondary to rupture of the internal iliac artery aneurysm was suspected, and an emergency operation was performed. At operation the aneurysm had not ruptured but overswelling perivesical vessels were found to have developed, and these fed a high blood flow to the bladder neck. In the present case cystoscopic examination injured the mucosa and led to massive hemorrhage from the bladder neck.     

Massive post ejaculation hematuria

The case of a twenty-nine-year-old white male with massive post-ejaculation hematuria, an entity distinct from hemospermia, is described. The site of bleeding was found to be large varicosities located at the apex of the prostate. Fulguration of the veins produced complete resolution of the bleeding.     

Massive intratubular hemorrhage with herniations into renal veins: report of a case

A 24-year-old man had unilateral gross hematuria that required nephrectomy. Pathological examination revealed massive intratubular hemorrhage and frequent deposition of an amorphous and homogeneous material positive for periodic acid, Schiff stain in the corticomedullary junction. This substance had the characteristics of Tamm-Horsfall protein and frequently herniated into the lumen of thin-walled veins of arcuate size. There was no apparent cause for the bleeding. To the best of our knowledge this is the third reported case with these peculiar findings and no apparent cause. We discuss some hypotheses as to the etiopathogenesis of this rare and intriguing condition.     

Carcinoma of urachus: report of 3 cases and review of literature

Three cases of urachal carcinoma are presented. Chief complaints were passage of mucous urine in a 58-year-old man (case 1), hematuria and frequency in a 63-year-old woman (case 2) and hematuria in a 45-year-old man (case 3). Urine cytology were negative for all cases and serum CEA level was elevated in case 1. Mass in the area of the bladder dome were revealed by cystoscopic examination in all cases. CT scanning, TUR biopsy and cystogram were valuable diagnostic procedure. En bloc segmental resection were performed on all cases, and case 1 and case 2 have been well without disease for 36 and 40 months, respectively. Case 3 died 65 months after operation with disseminated carcinoma. Histologically mucin-producing adenocarcinoma were found in all cases. Statistic examination and discussion are made of 237 cases of urachal carcinoma reported in Japan.     

Ureteroscopic evaluation and laser treatment of chronic unilateral hematuria

PURPOSE: Chronic unilateral hematuria is characterized by intermittent or continuous gross hematuria that cannot be diagnosed using standard radiology and hematology methods. We evaluated patients with unilateral renal hematuria to determine the cause of bleeding and investigated the usefulness of ureteroscopic laser treatment for this condition. MATERIALS AND METHODS: In a total of 23 patients with chronic unilateral hematuria radiology and hematology tests failed to reveal the source of hematuria since no abnormal findings could be detected. Preoperative urine cytology also showed no abnormalities. Subsequently all patients were investigated via ureteroscopy. In the case of a lesion being identified after complete inspection of the collecting systems the bleeding site was treated ureteroscopically with a holmium:YAG laser alone or in combination with a neodymium:YAG laser. RESULTS: The entire ureter and intrarenal collecting systems were inspected in all patients. Discrete lesions were found via ureteroscopy in 18 patients, including minute venous rupture in 14, hemangioma on a renal papilla in 2 and calculus in 2. In the remaining 5 patients no lesions were detected by ureteroscopic evaluation. Nine of the 18 patients with detected lesions were treated ureteroscopically with the laser because active bleeding spots were recognized during the ureteroscopic procedure. In all treated patients hematuria resolved with no recurrence during a median followup of 73 months (range 18 to 110). CONCLUSIONS: A patient in whom the cause of hematuria is unknown should undergo ureteroscopic evaluation. Ureteroscopic laser treatment is an excellent method for chronic unilateral hematuria.     

Foreign body in lower urinary tract

A forty-four-year-old white man had a stout rubber cable extruding 2 cm. from the external urethral meatus. He had introduced an 82-cm. rubber cable via his urethra into his bladder to assist in clearing dysuria and hematuria. Suprapubic removal of the rubber cable was accomplished, and his postoperative course was benign.     

Late metastases of prostatic adenocarcinoma to urinary bladder after radical prostatectomy: a case report]

We report a case of metastasis of prostatic cancer to urinary bladder. A 67-year-old man was admitted with a complaint of macroscopic hematuria, who had undergone radical prostatectomy and surgical castration for prostatic cancer (pT3N0M0) 53 months before. Computed tomographic (CT) scan revealed an invasive tumor on the right wall of the urinary bladder and swelling of paraaortic and pelvic lymph node metastases. These lesions were diagnosed as bladder tumor with lymph node metastases, and then transurethral biopsy of bladder tumor was performed. Because macroscopic hematuria could not be controlled and severe progressive anemia was found after the biopsy, simple cystectomy and bilateral cutaneoureterostomy were performed on the next day. Histopathological analysis showed that the tumor was adenocarcinoma, which was thought to be a metastatic tumor from the prostatic cancer.     

Nutcracker syndrome associated with severe anemia and mild proteinuria

A 70-year-old man was referred to our hospital with the chief complaint of gross hematuria. Urinalysis revealed gross hematuria (3+, RBC 100/HPF or more) and mild proteinuria (3+, 1.8 g/day) with no urinary casts. Computed tomography of the abdomen showed compression of the left renal vein between the superior mesenteric artery and the aorta. Ultrasonography showed an increased flow velocity at the stenotic portion of the left renal vein. An aortography and selective left renal arteriography showed that there was no evidence of tumor vessels or arterial abnormalities in the arterial phase. However, the venous phase revealed a stenosis of the left renal vein just lateral to the aorta as well as a reflux of contrast material toward the left gonadal vein which was dilated. In addition, cystoscopy revealed left ureteral bleeding. Based on these findings, we made the diagnosis of gross hematuria caused by nutcracker syndrome (NCS). We concluded that the main cause of the anemia and proteinuria in our patient was leakage of blood and this is confirmed by the relationship of red blood cells to protein in the urine because we proved whole blood and plasma protein loss in the urine by calculation. Fourteen months after discharge, both the gross hematuria and proteinuria spontaneously disappeared. This case strongly suggested that the first therapy for hematuria and proteinuria with NCS should be observation.     

Resolution of cirrhotic glomerulonephritis following successful liver transplantation

A 38-year-old man with liver failure due to Laennec's cirrhosis developed nephrotic range proteinuria and hematuria. Renal biopsy showed membranoproliferative glomerulonephritis with 2+ staining for IgA and complement consistent with cirrhotic glomerulonephritis. After orthotopic liver transplantation, proteinuria and hematuria rapidly resolved. This case indicates that glomerulonephritis associated with cirrhosis may be successfully treated with hepatic transplantation. Whether the improvement in glomerular abnormalities resulted from immunosuppression therapy or from restoration of normal hepatic function is unknown.     

膀胱平滑肌瘤的诊断和治疗

目的 探讨膀胱平滑肌瘤的病因、诊治方法和预后。方法 回顾性分析1984年至2005年收治6例膀胱平滑肌瘤患者资料。患者男1例，女5例，平均年龄36岁。临床表现为排尿障碍4例、血尿1例、膀胱刺激症状1例。病程1～16个月。除1例血尿患者外，其余5例均非首诊。6例B超检查，首次发现病变3例。5例行CT检查，均发现肿块且有不同程度强化。6例膀胱镜检，发现肿瘤2例，提示占位病变3例。肿瘤直径1．5-5．0cm。6例均采用手术治疗。结果 6例患者术后排尿通畅，血尿消失，排尿刺激症状明显缓解。1例术后出现伤口漏尿，经保守治疗治愈，余未发生其他并发症。6例随访9个月～8年，未见肿瘤复发或转移。结论 膀胱平滑肌瘤是一种少见的良性肿瘤，临床症状不典型，排尿障碍和血尿是最常见的表现，诊断主要依靠B超、CT和膀胱镜检查，初诊时误诊率较高。外科手术治疗预后良好。     

Liver Transplantation: Does Prolonged Storage Promote Non-Anastomatic Biliary Structures?

A case of a 70 year old man who was found to have an extrahepatic portal vein aneurysm during an evaluation for hematuria is reported. Extrahepatic portal vein aneurysms are rare with only twenty cases reported in the literature. Typically, patients present with hemorrhage requiring surgical exploration or the aneurysm is discovered during evaluation of another abdominal process. Management includes careful follow-up in the asymptomatic patient without underlying liver disease or portal hypertension.     

Transarterial coil embolization in treatment of gross hematuria following self-inflicted stab wound in a horseshoe kidney

Horseshoe kidney is an uncommon anomaly of the urinary system with an increased risk of injury during penetrating and blunt abdominal traumas.Selfinflicted abdominal stab wound,a rare type of abdominal...