Primary hydatid cyst of the psoas: report of 2 cases

We report two patients with hydatid cyst of the right psoas muscle who presented with lower back pain and a palpable mass on the right side. The diagnosis was confirmed by computed tomography [CT] in both patients and by positive hydatid serology in one case. Intervention consisted of a pericystectomy in both cases. After a follow-up of 24 and 30 months, respectively, the hydatid serology is negative in both patients and the findings on control CT are normal. Based on these two cases and a review of the literature the authors discuss the diagnosis and treatment of this rare entity

[HIV infection revealed during the treatment of a unilateral abscess of the psoas muscle]

We report the case of a 25-year-old unmarried male patient who presented with painful swelling of the right lumbar area of one month's duration, associated with fever and general debility, but without any urological or gastro-intestinal symptoms. He admitted having had unprotected sexual intercourse. Abdominal radiography revealed an abscess in the right psoas muscle, which was drained by lumbotomy. Analysis of the pus revealed Staphylococcus aureus. Histological examination of the abscess wall found non-specific inflammation. A test for tuberculosis was negative, while serological examination revealed HIV. The patient was treated with antiretroviral drugs

[Diagnosis and treatment of penile tumors, report of 2 cases and review of the literature]

Squamous cell carcinoma of the penis is rare, representing less than 1% of all adult cancers. The etiology of this cancer is still unknown, but many risk factors have been suggested, above all the human papilloma virus. The authors describe two cases of infiltrating penile tumors. The first patient presented with a glandular tumor of 5 cm which was treated by a distal penile amputation. The second patient had a ventrally located penile tumor associated with a urethral fistula. He was subjected to total penectomy with bilateral inguinal lymphadenectomy. Postoperatively, he developed lymphorrhea which resolved spontaneously. Surgery remains the treatment of choice for penile tumors and consists - depending on the case - of wide excision, partial or total penectomy with perineal urethrostomy

[Management of penile fracture]

Objectives: To evaluate our experience with the management of penile fractures

Patients and Methods: We retrospectively studied 30 cases of trauma to the erect penis seen at the Urology Department of Mohammed VI University Hospital, Marrakech, Morocco between January 2001 and January 2004. In general, the patients presented between 3 hours and 10 days after the injury, however the majority [25 patients] presented within 12 hours after the injury. The mean age of the patients was 33 years [range: 17 - 70 years]. The diagnosis of penile fracture was entirely based on clinical features. The commonest cause of penile fracture was violent sexual intercourse [12 cases]. The injury involved unilateral corporeal rupture in all patients with the length of the fracture site varying from 1 to 3 cm. Surgery involved an elective incision on the site of the fracture in all patients. Hospital stay ranged from 1 to 2 days. All patients were followed up for at least 6 months

Results: The postoperative period was uneventful in all patients but one who developed infection of the incision. At follow-up 3 months after the intervention, all patients were able to have a painless sexual intercourse and reported an adequate erection without erectile dysfunction or penile curvature

Conclusion: Our results show that an elective incision is a reliable method to treat unilateral penile fracture without urethral trauma

[Abscess of the psoas: diagnostic and therapeutic aspects]

Objective: Abscess of the psoas which was first described by Mynter in 1881[1] is a rare disease. Herein, the authors report on their experience with the treatment of this pathology

Patients and Methods: Between January 1999 and December 2002, 15 patients with abscess of the psoas were seen at our department. They were 12 males [80%] and 3 females [20%] with a mean age of 53 years [range: 27 - 70 years]. Mean hospital stay was 6 weeks [range: 2 - 24 weeks]. All patients were examined by abdominal ultrasonography, 9 by computed tomography. Surgical drainage via a small incision of 5 cm was done in 12 patients, while three patients received medical treatment in combination with a percutaneous drainage

Results: The clinical manifestation included fever in 9 [60%], psoitis in 6 [40%], a mass in the lumbar region in 5 [33%] and an inguinal mass in 3 [20%] patients. Hyperleucocytosis varying between 13000 and 340000/mm[3] was found in all patients. The main organisms isolated were staphylococcus aureus [54%], Koch's bacillus [38.4%], Escherichia coli [15%] and Klebsiella [8%]. De novo abscess of the psoas was found in 4 patients [26.6%], while it was secondary in 11 patients [73.3%]. Surgical drainage of the pus was done via the anterolateral extraperitoneal lumbar approach in 8 patients and via the high inguinal approach in 4 patients. In three patients medical treatment combined with percutaneous drainage was sufficient. The immediate outcome was good in all patients

Conclusion: The pathogenesis of de novo abscess of the psoas is unknown as yet, and its diagnosis remains a challenge for the physician. However, the precise clinical diagnosis and the choice of the therapeutic measures have been facilitated by the development of modern imaging facilities. Surgical treatment should be reserved to those cases where percutaneous drainage has failed