118 cases of orogenital tuberculosis in the south of Tunisia

The authors had for aim to study the epidemiological, clinical, therapeutic, and evolving features of urogenital tuberculosis [UGT] in the south of Tunisia. 118 patients presenting with UGT were retrospectively studied from January 1982 to December 2007 in South and Central Tunisia. The diagnosis of UGT was confirmed in all cases by clinical, biological, radiological, and/or histological data. 81 male and 37 female patients [mean age 38 years] were included. The most common presentation was storage lower urinary tract symptoms [57.6%]. General signs were observed in 25.4% of cases. The diagnosis of UGT was proven by bacteriological evidence [49.2%], positive bladder biopsy [12.7%], and pathological analysis of a surgical exeresis piece [68.6%]. The treatment was anti-bacillary chemotherapy for all patients, associated to a surgical excision [70.3%], reconstructive procedures [18.6%], and/or endoscopic manoeuvres [13.6%]. 80% of patients were regularly followed up for an average of 6 years. Favourable evolution was observed in 85.3% of cases. UGT remains a current severe disease because of the multiple risks that can result, especially for the renal function

Laterality of symptomatic recurrent calcium nephrolithiasis

Although it is presumed that both kidneys excrete similar urinary constituents, it is a general observation that the majority of patients present with unilateral stone disease. The aim of this work was to study the laterally of recurrence in calcium stone formers. In a retrospective study of 154 patients treated for recurrent symptomatic nephrolithiasis at our institution between January 1982 and December 2006, the side of stone formation was determined by an analysis of radiographic findings and symptomatic history. Patients with hydronephrosis, major renal anatomic anomalies and non-calcium stones were excluded from the study. The features of unilateral stone forming and bilateral stone forming were compared. Statistical analysis was done using Student's t-test. Of the 154 patients, 102 were males and 52 females with a male-to-female ratio of 1:2. One hundred and fourteen patients had unilateral stones [Group A], 64 [56%] on the left and 50 [44%] on the right side. In 40 patients they were bilateral [Group B]. Comparing Groups A and B, the mean age at the first stone episode was 41.5 versus 38.3 years, the mean interval between the first stone and recurrence was 9.6 versus 9.9 years, and the mean follow-up was 13.3 versus 14.9 years [differences not statistically significant]. In Group A, 101 patients [89%] had unilateral stone recurrence episodes with 86 of these 101 patients [85%] developing stones on the same side as the primary stone. Of the 40 patients with bilateral stone formation, 30 patients [75%] had bilateral stone recurrence episodes. Recurrent stone formers commonly present with calculi on the same side and the etiology of this phenomenon is unclear, but anatomic and external triggers should be considered

Adrenal myelolipoma: a rare entity

Adrenal myelolipoma is a rare, benign, non-functioning and often asymptomatic tumor of the adrenal gland. It may be complicated by pain or retroperitoneal hemorrhage. Diagnosis is mostly based on medical imaging which also helps to differentiate it from other adrenal incidentalomas by demonstrating its adipose composition. The treatment of choice for complicated, symptomatic or large adrenal myelolipomas is surgical excision. We report the case of a large adrenal myelolipoma in a 44-year-old male patient treated surgically

[Characteristics of emphysematous pyelonephritis: about four observations]

Emphysematous pyelonephritis is a severe infection which necessitates a management that is both medical and surgical. Early systematic antibiotic therapy is required. Percutaneous drainage is now the first urological approach in most cases. It should not however delay, if necessary, an eventual nephrectomy. We report our experience during 15 years in four women

Successful treatment of homozygous cystinuria with captopril

Cystinuria is an autosomal recessive hereditary disorder associated with nephrolithiasis and its attendant complications. Traditional management using oral alkali, D-penicillamine, or mercaptopropionyglycine in an attempt to increase urinary cystine solubility is often unsuccessful due to intolerable side-effects. The aim of this study was to determine, if captopril could reduce urninary cystine excretion in homozygous cystinuric patients. Three cystinuric patients with a history of multiple cystine stones despite previous traditional therapy were treated with 150 mg captopril daily for 3 years after determination of their baseline 24-hour urine cystine excretion. Cystine excretion studies were repeated subsequently at 6-month intervals. The baseline 24-hour urine cystine excretion was within the expected limits for homozygous cystinuria in all patients [1072, 962 and 959 mg cystine per gm creatinine per 24 hours]. After institution of captopril treatment, all patients had a significant decrease in urinary cystine levels [374,313 and 451 mg cystine per gm creatinine per 24 hours]. No patient experienced recurrent nephrolithiasis or adverse drug effects. We conclude that captopril can significantly decrease urinary cystine excretion in patients with homozygous cystinuria. Captopril should be considered an alternative to traditional drug management of cystinuria

Pure primary small cell carcinoma of the bladder- a propos of 5 cases

Pure primary small cell carcinoma [PSCC] of the bladder is a rare tumor, and patients commonly present with metastatic disease. No prospective studies evaluating the most efficient treatment have been published. We reviewed our experience with treating these tumors to evaluate their histopathological characteristics and clinical outcome. This study presents our experience in 5 patients with PSCC of the bladder during a 7-year period. The patients' tumor characteristics, therapy, follow-up and revival status were documented. All patients were male with a mean age of 67 years. The main clinical presentation was macroscopic hematuria. All tumors were invasive at the time of diagnosis. Systemic chemotherapy was given in 4 patients, and one patient was treated by radical cystectomy. The overall median survival was 17 months. PSCC of the bladder should be considered a systemic disease, because most patients present with metastases. Prospective studies are needed to determine the optimal treatment