Double Retroperitoneal Hydatid Localization: A Case Report

The hydatid cyst is a parasitic pathology which is endemic in Tunisia and presents a public health problem. Hydatid cysts located in the retroperitoneum, especially around or in the kidney, are rare and only represent 5% of visceral locations. The kidney is the most commonly affected organ of the urinary tract. The psoas muscle is an uncommon location and not less than 70 cases have been cited. We report the case of an unusual presentation of a right kidney hydatid cyst associated with a psoas muscle location. To our knowledge, this association of double retroperitoneal location has not been reported in the literature.

[Atypical renal cysts]

Background: Atypical renal cysts are suspicious for malignancy. It is hard in some cases to give a sharp radiological diagnosis and propose an appropriate management

Aim: To give the histological results of the operated atypical renal cysts and to establish a correlation between the radiological findings and histological features

Methods: Between January 2001 and December 2012, 22 patients have been operated in our department for atypical renal cysts. There were 10 type III and 12 type IV Bosniak lesions. We have reported clinical, epidemiological and radiological findings. We have analyzed the histological results taking into consideration the radiological findings

Results: According to histological findings, 7 among the 10 type III lesions were benign [70%]. However, only one case of benign tumor was noted in type IV lesions [8.3%]. There was no evident correlation between tumors size and histology. With a median follow up of 48 months, three patients died because of locally advanced tumors

Conclusion: Management of atypical renal cysts remains difficult. A careful computed tomography staging is essential before treatment. Type III and type IV Bosniak cysts were malign in 30% and 91% of cases, respectively. There was no correlation between tumor size and malignancy. A nephron sparing surgery should be proposed whenever possible

[ role of bisphosphonate in the treatment of bone metastases from prostate cancer]

Bone metastasis is very frequent in prostate cancer. It is a turning point that marks the severity of the disease. Before metastasis become symptomatic, treatment preventing bone events should be indicated. To evaluate the role of bisphosphonate in the treatment of bone metastases from prostate cancer. A review of literature. Bisphosphonates play a very important role to prevent bone mass loss and to reduce bone complication events. Bisphosphonates are recommended as preventive treatment at the time of diagnosis of bone metastatic prostate cancer

[adult's cryptorchidism: clinical and therapeutic aspects about 100 cases]

Cryptorchidism is a pathological condition defined as the failure of the testis descending into the scrotum. It is a rare condition in adults. To study clinical and therapeutic aspects of cryptorchidism in adults. A retrospective study of a series of 100 adult patients [mean age: 25.1 years; 19-50 years] with cryptorchid testis admitted in an urology department in Tunis. The main reasons for consultation were the finding of an empty purse, inguinal pain and primary sterility. The testicle was palpable in 84 cases. The treatment consisted of an orchidopexy in most cases and in 14 cases orchydectomy. Finding of cryptorchidism in adult is a real diagnostic failure. Surgical treatment is indicated to facilitate surveillance

[Eosinophilic cystitis: review of nine cases]

Eosinophilic cystitis is a rare inflammatory pathology. It remains a poorly understood entity. To report a series of adult cases of eosinophilic cystitis mimicking a bladder tumor. Retrospective study of cases of eosinophilic cystitis collected in an urology department. Diagnosis was established on a spontaneous bladder perforation in one case and on hematuria in the eight other cases. Histopatholgy studies confirmed the diagnosis. Eight patients underwent an endoscopic resection of bladder lesions followed by medical therapy with nonsteroidal anti-inflammatory drugs and cortimoxazole. An ileal bladder enlargement was performed in one case. Regular follow-up didn't reveal any recurrence. Eosinophilic cystitis is a rare disease simulating a tumor of bladder. Its clinical presentation is not specific and final diagnosis is based on pathology. Endoscopic resection will help to pathologic diagnosis. Associated to corticoids and antihistaminic drug endoscopic resection constitute the treatment of choice

[Sclerotherapy of idiopatic hydrocele with polidocanol: a study about 190 cases]

To evaluate the efficacy and side-effects of Polidocanol used as sclerosing agent for testicular hydrocele. One hundred and ninety men, with a median age of 55,9 years [40-89], treated for idiopatic hydrocele were assessed. After puncture and aspiration, the empty sac was instilled with 3% Polidocanol. We recorded recurrence, complications and associated pain on a visual analogue scale. With a median follow-up of 19 months, The cure rate of hydroceles after one sclerotherapy session was 62,1%, and the overall cure rate using the procedure was 82,6%. Re-instillation was done for recurrences in 41% of patients. Polidocanol therapy was almost pain-free. A low rate of complications was observed. Polidocanol is a useful sclerosing agent for treating testicular hydrocele. Due to its ease of administration, low frequency of complications, high rate of effectiveness, and excellent tolerability; we recommend sclerotherapy with polidocanol as the primary treatment for hydroceles

[Renal colic in pregnancy and lactation: diagnostic and therapeutic approaches]

Renal colics due to urinary stones are also common in women of childbearing age whether pregnant or not. Through a review of literature, we evaluated diagnostic and therapeutic approaches in renal colic in pregnancy and lactation. Review of literature. The clinical diagnosis is sometimes difficult requiring additional medical imaging based on ultrasound. Other radiological investigations using X-rays are formally forbidden. The prescription of analgesic treatment during pregnancy and lactation must take into account mainly the teratogenic risk in addition to maternal risk by altering drug pharmacokinetics during pregnancy. During pregnancy, NSAIDs are prohibited because of their teratogenicity effect. Salicylates and opiates should be used with care, especially in cases of threat of confinement. Paracetamol remains the treatment of choice. Salicylates and corticosteroids should be used with caution during lactation

[Intradiverticular tumors of the bladder: diagnostic and therapeutic problems about 32 cases]

The transitional cell carcinoma within the bladder diverticular is a rare and poorly known entity. To evaluate diagnostic and therapeutic approaches of transitional cell carcinoma within the bladder diverticular. Thirty men and two women [median: 70 years; 44- 83 years] were included. The main reason for consultation was hematuria. The intra-diverticular tumor was suspected by radiological assessment in 9 patients only. All these patients underwent an endoscopic resection of the tumor. The histological study concluded to a pta stage in 16 patients, pt1 stage in 8 patients and invasive tumors in 8 patients. A complementary endovesical BCG-therapy was performed in patients with superficial tumors and a radical cystectomy in patients with invasive tumors. With an average follow-up of 27 months, seven recurrences were found in the group of superficial tumors, including 3 cases of progression to invasive stage. Bladder intra-diverticular tumors are rare and more common in elderly. In a bladder diverticulum, there are superficial tumors [pta, pt1] which are the most frequent and invasive tumors. Radical cystectomy is the gold standard for invasive tumors.Endoscopic resection combined with endo-vesical immunotherapy should be reserved for superficial tumors

[Bellini renal cell carcinoma: diagnosis and treatment. a report of 7 cases]

The Bellini collecting duct carcinoma [CDC] is a very rare form of renal cell carcinoma [1%] associated with an extremely poor prognosis. To study clinical and radiological characteristics of CDC. From 1993 to 2002, 7 patients with CDC were treated at our institution. The diagnosis of CDC was made by a nephrectomy specimen in all cases. Demographic, clinical, pathological and survival data were gathered. They were five men and two women with an average age of 63 years. Lumbar pain and hematuria were the main symptoms. At presentation 2 T1N0M0, 1 T2N0M0, 1 T3N0M0, 1 T3N+M0 and 2 T4N+M+ tumors were seen. All patients underwent a radical nephrectomy. The two patients who had TNM stage I disease survived without evidence of disease at 5 years and 11 years respectively. Patients with a T4N+M+ tumor experienced rapid progression and died respectively at 3 and 5 months after nephretomy. The 3 other patients with T3N+M0, T3N0M0 and T2N0M0 disease; respectively; progressed rapidly and were lost to follow-up after one year. CDC is an aggressive variety of kidney neoplasm that is often associated with nodal and visceral metastases at presentation. It is associated with poor prognosis. For the majority of patients surgical treatment will not result in a cure. Early detection may be the best method for prolonging patient survival

[Ejaculation prematuree et retardee]

Frequently met in clinical sexology as in general medicine, ejaculatory troubles had a multifactorial etiopathogeny and are subjects to controversies. Their therapies remain difficult despite different possible approaches

[ female urethral diverticulum analysis of 27 cases]

To assess the clinical, radiological and therapeutic aspects of the female urethral diverticula through a series of 27 cases. Twenty seven women, with a mean age of 36.2 years [range 22 to 62 years] presenting a urethral diverticula, were treated between 1990 and 2008. Clinical examination made diagnosis in all cases. The urethral diverticula were excised via a transvaginal approach in all cases but one who refused surgery. twenty four patients had favorable immediate outcome. Diverticular recurrence was not reposted in any case. After a median follow-up of 22 months only three patients have some urinary urgency that was treated by anticholinergics. Urethral diverticular should be suspected in all cases of female lower urinary tract symptoms. The diagnosis is made by clinical examination and radiologic investigations. Transvaginal surgical excision gives the best results

Circumcaval ureter with a synchronous ipsilateral transitional cell carcinoma of the upper urinary tract and the urinary bladder

We report a case of concomitant ureteral transitional cell carcinoma [TCC] developed in a circumcaval ureter associated to an invasive bladder cancer. Diagnosis was made by intravenous urography [IVU] and contrast-enhanced computed tomography [CT] scanner which showed a typical [J] shaped deformity in the dilated proximal ureteric segment with moderate right hydronephrosis and pelvic filling defect associated to bladder filling defect due to a bladder tumor. The patient underwent a radical cystoprostatectomy and nephroureterectomy; no recurrence was detected after a 12 months period of follow-up

[Uretero pelvic junction obstruction complicating a crossed renal ectopia]

Report a case of a uretero-pelvic junction obstruction complicating a crossed renal ectopia. 49-year-old woman, complained an abdominal mass. Radiological investigations concluded to a non functioning right kidney in a crossed ectopia. Surgery was decided and the diagnosis of crossed fused renal ectopia destroyed on an ureteropelvic junction obstruction was established. This kidney was nephrectomised with good outcome