[Genito-urinary tuberculosis inthe male, apropos of 22 cases]

An evaluation of the epidemiological, clinical, prognostic and therapeutic characteristics of male genito-urinary tuberculosis, complemented by review of the literature. We retrospectively studied 22 patients with confirmed genitor-urinary tuberculosis. The diagnosis was based on clinical, bacteriological, radiological and histological findings and radiological examination. The most common presenting symptom was chronic epididymitis [11 patients] followed by scrotal fistula [6 cases], obstructive uropathy [3 cases], hydrocele [6 cases] and infertility [1 case]. Clinical examination revealed epididymal nodules in 11 and hydrocele in 10 patients. Leucocyturia was found in one patient. Scrotal ultrasound demonstrated epididymal lesions in 8 cases. The definite diagnosis was based on histological examination of resected specimens [13 cases], biopsy specimens [8 cases] and on the discovery of the tubercle bacillus in the urine [1 case]. Intravenous urography, which was carried out routinely, detected associated urinary lesions in 5 cases. The follow-up was uneventful in all patients. The diagnosis of male isolated genitor-urinary tuberculosis is difficult in the absence of an endemic prevalence of tuberculosis. Any longstanding epididymo-orchitis should raise the suspicion of tuberculous etiology, especially in cases with hypofertility. Medical treatment has proven effective in early diagnosed cases, while surgery is reserved for resistant or complicated cases

[Treatment of iatrogenic ureteral injuries. A propos of 24 cases]

To evaluate the diagnosis and treatment of 24 patients with ureteral injury at our institution. In this retrospective study we evaluated 24 patients [22 females and 2 males] with ureteral injury treated at our institution between June 1993 and June 2005. The average age was 41 years [range 22-65 years]. the majority of ureteral injuries occurred during gynecological surgery [22/24 cases = 92%]. The time elapsed between the ureteral injury and diagnosis was 5 months on average; only in one case [3.8%], the injury was discovered during surgery. Four patients were treated endoscopically while ureteroscopy and end-to-end anastomosis was applied in 5 and open surgery in 15 cases. End-to-end ureterorraphy with placement of a double-J catheter was necessary in one patient, where endoscopic treatment had failed. After an average follow-up period on 60 months, loin pain had resolved in all cases. On radiological evaluation, a residual uretero-pyelocalyceal hyptony was noted in 5 cases and a satisfactory ureteral passage without strictures in the others. No nephrectomy was necessary in this series. Ureteral injury is most often secondary to gynecological surgery. In the majority of cases endourologic repair is the treatment of choice. It is recommended to pass ureteral catheters pre-operatively in order to ease the repair of the injury

[Foreign bodies of the bladder [report of 4 cases]]

Foreign bodies of the bladder have been amply reported in the literature either describing their origin or the circumstances of insertion. Their presence may often be a consequence of questionable actions performed by mentally unstable persons, but it might also be due to an accidental insertion during transvesical medical procedures or to migration of the foreign body from the perivesical area during interventions on surrounding areas. The authors herein report four different kinds of vesical foreign bodies: a textiloma, a calculus formed on a non-absorbable suture filament attached to the bladder wall, migration of osteosynthetic material and migration of an intrauterine device