Traumatisme des bourses : aspects cliniques et thérapeutiques au service d'urologie du CHU Gabriel Toure

Objectif : Notre travail avait pour but de décrire les aspects épidémiologiques, cliniques, paracliniques et thérapeutiques des traumatismes des bourses dans le service d'urologie ­ andrologie du CHU Gabriel Touré de Bamako au Mali. Matériel et Méthode : Il s'agissait d'une étude rétrospective portant sur 13 dossiers de patients qui ont été pris en charge au service d'Urologie-Andrologie l'hôpital Gabriel Touré du Mali pour traumatisme des bourses durant la période allant de Février 2006 à Janvier 2013. Les paramètres suivants ont été étu dié : la fréquence, l'âge, les étiologies, le motifet le délai de consultation, les résultats de l'examen clinique, le protocole de traitement adopté et l'évolution. Résultats : La moyenne d'âge était de 28 ans avec des extrêmes de 1an et 46 ans. Les circonstances de survenue étaient dominées par les accidents de la voie publique (12 cas), une agression par armes à feu. Le délai de consultationvariait entre 1heure à 1jour. La grosse bourse douloureuse était le motif de consultation le plus fréquent (n=12). A l'examen physique le traumatisme était fermé dans 10 cas, et ouvert dans 3 cas. Sur le plan thérapeutique, 7 de nos patients ont subi une intervention chirurgicale et 6 un traitement conservateur (surveillance + anti-inflammatoire).Les gestes chirurgicales ont consistés; à une plastie des enveloppes scrotales et péniennes (n=2), une orchidopexie, une uretroplastie (n=1), un parage et drainage de la vessie, une orchidectomie. Le séjourmoyen en hospitalisation a été de 5 jours avec des extrêmes d'un jour et 1mois. Les suites opératoires immédiates ont été simples chez tous les patients sauf deux. Conclusion : Une exploration chirurgicale doit être réalisée en cas d'hématocèle ou de rupture de l'albuginée testiculaire à l'échographie. Une prise en charge précoce permet de préserver la fonction gonadique

Reporte de seis casos de úlceras genitales durante la inducción en leucemia aguda promielocítica con ácido all-transretinoico y revisión bibliográfic / Report of six cases of Genital Ulcers during induction therapy of Acute Promyelocytic Leukemia with ATRA and review of literature

El ácido all-transretinoico (ATRA) es uno de los mayores avan-ces en el tratamiento de las leucemias promielocíticas agudas (LPA). Con el uso asociado de quimioterapia y corticoides hacen de ésta leu-cemia las de mejor pronóstico hematológico con altas tasas de cu-ración. El ATRA es generalmente bien tolerado pero puede presen-tar efectos adversos sistémicos, englobados dentro del denominado sindrome ATRA (SATRA), o efectos directos gastrointestinales y mu-cocutáneos tales como las úlceras escrotales, transitorias y de buena respuesta clínica, tratándose de una entidad diferente al SATRA con presencia de vasculitis en el estudio anatomopatológico. En la revisión que realizáramos, hemos detectado 44 casos reportados en la literatu-ra a los que hemos agregado, en el siguiente documento, seis pacientes evaluados en nuestra institución con úlceras genitales asociadas al uso de ATRA, cuatro de ellos con presencia de vasculitis como lesión histo-lógica y un paciente con diagnóstico de síndrome Sweet

All-trans retinoic acid (ATRA) is one of the greatest advances in the treatment of Acute Promyelocytic Leukemia. The combination of all-trans-retinoic acid (ATRA), chemotherapy and corticoids has made acute promyelocytic leukemia (APL) a highly curable leukemia. The ATRA is generally well tolerated. Adverse effects, include ATRA syndrome (SATRA), and the gastrointestinal and mucocutaneous side effects, such us scrotal ulcers, wich are transitory and with a good clinical response. They are a different entity to SATRA, and presents vasculitis in the histological study. Of our knowledge, 44 cases were reported in the literature, we present the following document with six patients evaluated at our institution with genital ulcers associated with ATRA, four of them present vasculitis in pathological study, and one patient Sweet ́s Syndrome

Priapismo de alto flujo postraumático en paciente pediátrico tratado con embolización arterial selectiva / Postraumatic high-flow priapism in pediatric patient treated with selective arterial embolization

El priapismo arterial es una rara patología en pacientes pediátricos, originada por una fístula entre la arteria cavernosa y los sinusoides del cuerpo cavernoso, habitualmente secundaria a un traumatismo perineal. Presentamos el caso de un varón de 16 años con priapismo arterial de 5 días de evolución tras una caída a horcajadas, tratado satisfactoriamente mediante embolización arterial supraselectiva con material reabsorbible. Seis meses después, el paciente presenta detumescencia completa sin disfunción eréctil asociada. La embolización arterial en pacientes pediátricos es compleja debido al menor calibre arterial y la necesidad de control de la arteria pudenda interna contralateral para evitar el desarrollo de complicaciones. La utilización de material reabsorbible permite disminuir el riesgo de disfunción eréctil posterior y, aunque presenta un mayor índice de recurrencias, constituye una alternativa eficaz en el tratamiento de esta patología.

Arterial priapism is a rare condition in pediatric patients, caused by a fistula between the cavernous artery and the sinusoids of the corpus cavernosum, usually secondary to perineal trauma. We report the case of a 16 year old child with arterial priapism of 5 days duration following a fall astride, successfully treated by superselective arterial embolization with absorbable material. Six months later the patient had complete detumescence without secondary erectile dysfunction. Arterial embolization in pediatric patients is complex due to the smaller arterial size and the need to control the contralateral internal pudendal artery to prevent the development of complications. The use of absorbable material helps reduce the risk of subsequent erectile dysfunction and, although it has a higher rate of recurrence, is an alternative for the treatment of this pathology.

Tumores del cordón espermático y las túnicas escrotales / Spermatic cord and scrotal tunica tumors

Entre los tumores paratesticulares, los del cordón espermático y las túnicas escrotales son los más frecuentes y en su mayoría benignos. En este trabajo se realizó la actualización del tema; se hizo énfasis en aspectos del diagnóstico y tratamiento. Se efectuó una búsqueda bibliográfica en libros de consulta, así como en las bases de datos de Hinari, PubMed/MEDLINE, LILACS y en el motor de búsquedas de Google, entre el 2009 y el 2013. Se utilizaron los términos del MeSH, en idiomas español e inglés: tumores paratesticulares, tumores intraescrotales, tumores del cordón espermático y tumores de las túnicas escrotales. Clínicamente, es básico realizar el diagnóstico diferencial con la hernia inguinal y con el hidrocele. El ultrasonido es el estudio de imagen de elección para su valoración inicial, aunque por su inespecificidad se recurre a la tomografía axial computarizada y a la resonancia magnética nuclear, para obtener más detalles. Para establecer el diagnóstico de certeza, se recomienda la biopsia por congelación transoperatoria, vía inguinotomía. La citología aspirativa con aguja fina, es una opción confiable para clasificarlos si existe sospecha preoperatoria de benignidad, es posible la tumorectomía en los benignos y se evita la orquiectomía radical con ligadura alta del cordón espermático, indicada para los malignos. Una vez confirmado el diagnóstico histológico y el estadio, el manejo debe ser onco-urológico para decidir la conveniencia de tratamientos adyuvantes. Los tumores malignos recurren con mucha frecuencia y a veces tardíamente, lo que obliga al seguimiento estricto y prolongado de estos pacientes.

Among the paratesticular tumors, the spermatic cord and the scrotal tunica tumors are the most frequent and benign. This paper updated this topic, making emphasis in diagnosis and treatment issues. A literature search was made in books and in Hinari, PubMed/MEDLINE, LILACS databases and in Goggle in the period of 2009 through 2013. The MeSH terms in English and Spanish were used: paratesticular tumors, intrascrotal tumors, spermatic cord tumors and scrotal tunica tumors. From the clinical viewpoint, it is fundamental to make the differential diagnosis with the inguinal hernia and hydrocele. The US testing is the imaging study of choice for initial assessment, although its lack of specificity makes specialists to resort to computer axial tomography and nuclear magnetic resonance to have more details of the case. For the purpose of reaching a precise diagnosis, the transoperative freezing biopsy through inguinotomy was recommended. The fine needle aspiration cytology is a reliable option to classify them if the case is suspected of benignancy preoperatively. It is possible to perform tumorectomy in the benign tumors, thus avoiding radical orchiectomy with upper ligature of the spermatic cord, which is the indicated approach to the malignant ones. Once the histological diagnosis and the staging are confirmed, the management should be oncological and urological in order to decide whether the adjuvant treatments are convenient or not. The malignant tumors recurred very frequently and sometimes in later phases, so these patients must be strictly followed-up for a long time.

Metástasis testicular de un adenocarcinoma de colon: reporte de un caso / Testicular matastases in colon adenocarcinoma: a case report

Reportamos el caso de un paciente con metástasis hepáticas, secundarias a adenocarcinoma de colon, quien presentaba una masa paratesticular dolorosa, cuya aparición coincidió con una progresión de la neoplasia de base. La resección quirúrgica de la masa identificó células neoplásicas provenientes del adenocarcinoma de colon.

We report the case of a patient with hepatic metastases secondary to colon adenocarcinoma. Who presented a par testicular and pain mass, which apparitions coincide with a progression of his basic neoplasic. The surgical resection of the mass identifies neoplásica cells with colon adenocarcinoma origin.

Carcinoma basocelular de localização inguinoescrotal: relato de caso

Carcinoma basocelular é neoplasia cutânea de alta incidência no Brasil.Caracteriza-se por sua associação com pacientes de pele clara, exposição solar crônica e a localização das lesões em áreas fotoexposta.A incidência de metástases é excepicional,ocorrendo a cada 10.000 e 35.000 casos.Localização na região perineal é rara e,quando presente,a hipótese de carcinoma basocelular é raramente aventada e o diagnóstico final,postergado.Há referência de que a possibilidade de metástases cresce quando o carcinoma basocelular é de localização perineal.

Gunshot wound injuries to the male external genitalia

To identify the patterns of civilian gunshot wound [GSW] injuries to the male external genitalia, and to present our experience in the management of such injuries. This descriptive study was carried out in the Urology and Nephrology Center, Al-Thawra Modern General and Teaching Hospital, Sanaa, Yemen from June 2005 to April 2008, and included 20 men that presented with GSW injuries to the external genitalia. After clinical and radiological evaluation with retrograde urethrography when indicated, early surgical repair was undertaken for all patients with evident, or suspected deep genito-urinary wounds. The mean age of the patients was 33.2 years. In 15 [75%] patients, injuries were inflicted by high-velocity weapons, and in 5 by low-velocity pistols, and 18 [90%] patients had other associated injuries. The penis was involved alone in 10 [50%], scrotum in 4 [20%], and the penis and scrotum in combination in 6 [30%] patients. In 5 patients, the lesions were superficial. Corporeal injuries were detected in 13 patients, and urethral injuries were detected in 6 patients. In post-repair, mild curvature during erection was experienced by 5 patients, severe angulation by one, and sexual dysfunction by 2 patients. We encountered 9 testicular ruptures, and our testicular salvage rate was 45.5%. Although the dominant inflicting weapons were high-velocity automatic rifles, the severity of injuries and their related outcomes were almost comparable to other low-velocity series. This is possibly due to the primary involvement of nearby bulky muscles in 90% of cases, which may absorb the blasts' effect of the projectiles on the genitalia

Les grosses bourses douloureuses de l'enfant

But : Evaluer la frequence; identifier les causes et decrire la prise en charge des grosses bourses douloureuses de l'enfant. Materiel et methode: Il s'agit d'une etude transversale portant sur 57 dossiers d'enfants ages de 0 a 15 ans recus et traites pour grosses bourses douloureuses. Ces enfants ont ete admis dans le service de la chirurgie pediatrique du CHU-Tokoin entre janvier 2003 et decembre 2007. Resultats : Les grosses bourses douloureuses ont represente 5;80des cas de grosse bourse. L'age moyen etait de 4;75 ans (extremes : 7 jours et 15 ans). Les principales etiologies etaient : la hernie inguino-scrotale etranglee (49;12) ; la torsion du cordon spermatique (29;83) ; l'orchi-epididymite (17;54) et le traumatisme testiculaire (3;51). Le delai de prise en charge etait superieur 72 heures dans 49;12des cas. La douleur et l'augmentation du volume de la bourse etaient presentes dans tous les cas. Le traitement avait ete chirurgical d'emblee (torsion du cordon spermatique et traumatisme testiculaire) ou en differe huit jours apres l'episode aigu (hernie inguino-scrotale etranglee); et medical (orchi-epididymites). Les suites operatoires ont ete simples dans tous les cas. Conclusion : Le diagnostic et la prise en charge des grosses bourses douloureuses doivent etre precoces afin d'eviter d'eventuelles complications

Empalamiento inguinal: presentación de dos casos clínicos / Inguinal impalement: report of two cases

BACKGROUND: Traumatic inguinal lesions in children are relatively unusual and those caused by impalement are less common. The purpose of this paper is to demonstrate the clinical course of two similar cases. CLINICAL CASES: A 13-year-old male and a 7-year-old female are presented in this report. During an accidental fall, they sustained an inguinal wound. In the emergency room, a wooden stake and a metallic bar were seen in the inguinal region. The surgical procedure shows absence of vascular, neurological, visceral and testicular damage. Both wounds caused by foreign bodies were subcutaneous and removed without complications. CONCLUSIONS: These types of accidents are uncommon and the absence of damage is the most relevant issue.

Scrotum injury by scorpion sting

Androctonus crassicauda is the second most frequent causes of scorpion sting in south-west Iran. Its venom can cause sever pain, autonomic, central nervous system [CNS], muscle function disturbances, and death. Appropriate medical and nursing cares can lead to complete recovery with no sequel. The majority of scorpion stings are oligosymptomatic, occurring mainly on the hands and feet [about 90%]. Here one rare case of a scorpion sting on the scrotum is reported from Kashan, central Iran

Traumatismes des bourses : a propos de 14 Observations

Objectif : Le but de ce travail est de rapporter les aspects epidemiologiques; cliniques; paracliniques et therapeutiques des traumatismes des bourses a partir d'une serie observee au service d'Urologie-Andrologie de l'hopital A. Le Dantec de Dakar. Patients et methodes: Il s'agit d'une etude retrospective; allant de Juillet 1986 a Juillet 2002; de 14 patients pris en charge au service d'Urologie-Andrologie de l'hopital A. Le Dantec de Dakar pour traumatisme des bourses. L'age moyen de nos patients etait de 28 ans. La cause principale etait les accidents de la voie publique.Resultats: Le motif de consultation le plus frequent etait la grosse bourse douloureuse (n=10). Le delai moyen de consultation etait court pour les traumatismes ouverts (45 minutes). Le traumatisme etait ouvert dans 4 cas et ferme dans 10 cas. Le traitement chirurgical a consiste en une orchidectomie (n=2); un parage suivi d'une suture des lesions (n=2); une evacuation d'hematocele avec reparation des lesions (n=6) et une cure d'hydrocele (n=1). Un traitement conservateur a ete realise chez trois patients. Le suivi a long terme n'a pas montre de complications chez onze patients. Deux cas d'atrophie testiculaire et trois cas d'oligo-asthenozoospermie ont ete rapportes. Conclusion : La precocite de la consultation; la systematisation de l'echographie des bourses dans les traumatismes fermes sans hematocele permettent une meilleure prise en charge et constituent le gage de la sauvegarde de la fonction gonadique

Carcinoma epidermoide en el escroto / Epidermoid carcinoma of the scrotum

Se presentó un caso de un paciente de 61 años de edad que acudió a Consulta Externa de Urología por presentar gran aumento de volumen de forma ulcerada y con secreción fétida en la región escrotal. Se orientó el ingreso y se diagnosticó un tumor de gran volumen (± 10 cm de diámetro). Se estudió y se decidió aplicar tratamiento quirúrgico, específicamente la exéresis amplia hasta bordes de sección sanos. Se dejó drenaje y se cerró por planos. El paciente mostró buena evolución en el estudio histopatológico y se demostró que la tumoración era un carcinoma epidermoide con bordes de sección sanos. Se realizó interconsulta con el servicio de dermatología y oncología y se orientó seguir la evolución del paciente(AU)

A case of a 61 year-old patient was presented that went to External Consultation of Urología to present great increase of volume in an ulcerated way and with fetid secretion in the region escrotal. The entrance was guided and a tumor of great volume was diagnosed (± 10 diameter cm). it was studied and he/she decided to apply surgical treatment, specifically the wide exéresis until healthy section borders. Drainage was left and he/she closed for planes. The patient showed good evolution in the study histopatológico and you/he/she was demonstrated that the tumoración was a carcinoma epidermoide with healthy section borders. He/she was carried out interconsulta with the dermatology service and oncología and it was guided to follow the patient's evolution(AU)

Utilization of skin flap for reconstruction of the genitalia after an electric burn

The objective of this article is to describe a case of an electric burn to the genitalia causing scrotal and testicular lesion, and the subsequent reconstruction using a skin graft. The patient was a 10-year-old boy who was victim of an electric burn that harmed the genitalia. There was extended skin loss, penile, scrotal and partial testicular lesion. The treatment consisted of plastic surgery to reconstruct the genitalia with skin flaps grafted on the left thigh, the scrotum and the base of the penis. The patient recovered well and was discharged after two weeks. We concluded that in severe cases of electric burns to the genitalia, skin graft offer a good therapeutic option.

Traumatic degloving lesion of penile and scrotal skin

Avulsions of penile and scrotal skin are uncommon events and are caused mainly by accidents with industrial machines and agricultural machine belts. We report the case of a 30-year old patient with avulsion and traumatic degloving of the penile and scrotal skin, with exposure of the cavernous bodies, spongy body, and testes due to an industrial machine accident. Reconstruction was performed in steps, achieving a satisfactory esthetic result, normal voiding and reestablished sexual function.

External genitalia injuries, a study of aetiological factors and management options

This study includes 35 patients, more than 12 years of age, with external genitalia injuries. They presented in the emergency Department of the Sir Ganga Ram Hospital, Lahore, during last 4 years [2000-2004]. Our main aim was to highlight the fact that most of these injuries are caused by rotating belt or wheel of a machine and are potentially preventable if proper precautionary measures are taken. Another aim was to discuss different management options. It has been concluded that rotating belt or wheel of a machine is the most common cause of these injuries, especially if someone is wearing loose traditional clothes

Scrotal ultrasound

To assess the role of ultrasound in evaluation of scrotal surgical condition, Fifty patients with acute scrotum [suspicion of torsion, acute epididymo - orchitis, trauma] or scrotal mass or clinically equivocal low grade varicocele in infertile men, their scrotums were checked by ultrasound [B-mode and color doppler ultrasound using 7.5 MHz linear probe]. We conclude that ultrasound is ideal in localization of scrotal pathology whether from Testis -Epididymis - Spermatic cord or from Scrotal wall. Doppler ultrasound is optimum test to differentiate acute epididymo- orchitis with normal or increased vascular flow from acute testicular torsion with absent flow to the testis and epididymis. All patients with hydrocele should be checked by ultrasound to exclude hidden causative testicular tumor or associated lesion. In blunt scrotal trauma, ultrasound exam aid to take immediate or early decision to do surgical exploration or to proceed in conservative treatment

Intoxicación por paraquat: toxicidad sistémica después de exposición cutánea / Paraquat poisoning: systemic toxicity after dermal exposure

La ingestión del Paraquat (dicloruro de 1,1 dimetil-4,4 dipiridilio) es el caso más común de la intoxicación fatal por plaguicidas, pero no se debe descartar la posibilidad de otras vías que lleven a un daño multiorgánico, como es el caso de la absorción dérmica del Paraquat. Nosotros reportamos el caso de un agricultor quien desarrollo daño renal y hepático después de una exposición aguda de la piel escrotal con el herbicida Paraquat con recuperación eventual del paciente. Este caso demuestra que la exposición dérmica por Paraquat, especialmente del escroto, puede producir seria toxicidad sistémica; siendo el primer caso reportado en 5 años en nuestro Instituto de toxicidad sistémica por contacto cutáneo de este químico. Se debe tomar estricta precaución, incluyendo el uso de ropa protectora siempre que se va a usar este químico.