Squamous and glandular metaplasia related to a renal pelvis stone leading to secondary pyeloureteral junction syndrome.

Keratinizing squamous metaplasia of the renal pelvis is a rare lesion of the upper urinary tract that can occur in the context of chronic aggression to the urothelium, potentially leading to a secondary pyeloureteral junction syndrome. We report the case of a 43-year-old patient discovered intraoperatively in relation to a renal pelvis stone causing a pyeloureteral junction syndrome. The extemporaneous histological examination ruled out a malignant process, and we performed a pyeloplasty according to KUSS-ANDERSON technique. This pathology should be recognized by the urologist for appropriate management. Treatment is conservative, with extended follow-up to detect recurrences or carcinomatous degenerations.

Prostate adenocarcinoma metastasis to the testis: A new case report.

Prostate cancer (PCa) in the second most common cancer in men worldwide. It commonly metastasizes to the bone, lymph nodes, liver and lungs. Synchronous or metachronous testicular metastasis is a rare finding, generally diagnosed incidentally after bilateral orchidectomy for hormonal management in patients with advanced PCa, or at autopsy. We report a case of a 55-year-old male, presenting a PCa and who developed a single testicular metastasis treated by radical orchidectomy, while he was under hormonotherapy.

Paratesticular leiomyoma: A case report of a rare entity.

Paratesticular leiomyoma is an extremely rare benign tumour. It is often asymptomatic. It is sometimes difficult to distinguish leiomyomas from malignant testicular tumours, which leads to radical orchidectomy, despite its benign nature. Magnetic resonance imaging can be helpful to make conservative management of this lesion.

Vesico-vaginal fistula in Tunisia: Epidemiology and risk factors of treatment failure.

INTRODUCTION: Vesico-vaginal fistula (VVF) is a global healthcare problem that has a high prevalence in developing countries. The aim of this work is to study the epidemiological, clinical and therapeutic characteristics of VVF post-obstetric and gynecologic procedures in order to identify the predictive factors of surgical treatment failure. METHODS: Data were collected from 132 VVF patients in our institution between 1985 and 2017. VVF was classified according to Zmerli's classification. Patients underwent surgical treatment and were evaluated after a follow-up period of 6 months. Successful treatment was defined as the absence of urine leakage whereas recurrence was defined as the presence of urine leakage immediately after the surgery or after a period of dryness with a confirmed VVF. Risk factors of surgical treatment failure were identified. RESULTS: The average age of patients was 44 years. The patients were multiparous in 62% of cases. VVF was consecutive to hysterectomy in 62.1% of cases, and after childbirth in 34%. VVF was retro-trigonal in 99 cases (75%) and trigonal in 33 cases (25%). The average size of the fistula was 1cm (0.3-2cm). VVF repair was performed by vaginal approach in 68% of cases and abdominal approach in 32% of cases. Treatment failure was noted in 36 patients (27%). Predictive factors of treatment failure were: vaginal fibrosis (P<0.001); trigonal location of the fistula (P<0.001); large diameter of the VVF>1cm (P<0.001); and complex and complicated fistulas (P=0.02). CONCLUSION: Although Tunisia is a developing country, the main cause of VVF was not obstetrical. Treatment failure, noted in almost one third of cases, was, in our series, correlated with the quality of the vaginal tissue, the size and the location of the fistula, and its complexity. LEVEL OF PROOF: 4.

A cadaveric anatomical study of the adrenals: Relationship with the posterior abdominal wall muscles revisited.

AIM OF THE STUDY: The main difficulties during retroperitoneal laparoscopic adrenalectomies are due to its location. Our objective was to define the relationship of the adrenals with the diaphragm and the psoas muscle. METHODS: Our work is an anatomical dissection of 80 fresh cadavers' adrenals. To study the right adrenal, we performed a right nephrectomy and adrenal remained attached to the Inferior vena cava by its main vein. On the left, the edges of the adrenal have been identified by needles and the adrenal was reclined to study its projection on the posterior muscular wall. RESULTS: The right adrenal is located higher, 13mm [4-20mm] above the medial arcuate ligament (MAL) in 16 cases (40%). Its lower border was at the same level as the MAL in 18 cases (45%) and 11mm [10-17mm] below the MAL in 6 cases (15%). The posterior support of the right adrenal was the right crus of the diaphragm (Right-CD) in 34 cases (85%) and straddling the Right-CD and the psoas in 6 cases (15%). The study of the relationships of the left adrenal with the MAL showed that the lower edge of the gland was at its same level in 16 cases (40%) and below in 24 cases (60%) by 14mm [8-24mm]. The posterior support of the left adrenal was the left crus of the diaphragm (Left-CD) in 16 cases (40%) and straddling the Left-CD and the psoas in 24 cases (60%). CONCLUSIONS: Our results showed that the right adrenal is higher. The MAL is an important posterior element to the adrenal gland that could serve as an anatomical landmark to identify the adrenal during laparoscopic adrenalectomy.

Splenogonadal fusion - a rare cause of scrotal swelling: a case report.

BACKGROUND: Splenogonadal fusion is a rare and benign condition. Diagnosis is challenging for clinicians. Despite its indolence, diagnosis is often confirmed after orchidectomy. Surgery is mandatory, particularly to rule out the extremely rare association with malignancy. CASE PRESENTATION: We report a case of splenogonadal fusion in a 38-year-old North African man presenting a palpable scrotal mass. We describe clinical aspects, pathogenic hypothesis, radiological features, as well as surgical management principles. CONCLUSIONS: Splenogonadal fusion is rarely suspected and diagnosed preoperatively. A diagnosis is made once an ectopic testicular mass is associated with cryptorchidism and suggestive radiological signs. A better knowledge of the clinical and radiological features of splenogonadal fusion provides an opportunity for conservative surgery.

Transitional Bladder Cell Carcinoma Spreading to the Skin.

Cutaneous metastases from bladder malignancies are rare. We report the case of a 74 year old man who underwent cysto-prostatectomy and adjuvant chemotherapy for a pT3b N+ bladder transitional cell carcinoma. Four months later, he presented with skin disseminated pigmented lesions. Skin biopsy confirmed cutaneous metastasis from urothelial carcinoma.

[Ileocolic intussusception from metastatic renal cell carcinoma]. / Localisation iléale d'un carcinome à cellules rénales révélée par une invagination iléo-cæcale.

The lung, the liver, the bone tissue and the brain are the most frequent sites for renal cell carcinoma metastasis. Small bowel metastasis from renal cell carcinoma is rare, with only few cases published. We report the case of ileal metastasis from operated kidney cancer revealed by ileocolic intussusception and causing intestinal obstruction in a 32-year-old woman.

[Cardiac metastasis of renal cell carcinoma, a rare location]. / Métastase cardiaque du cancer du rein : site inhabituel.

The renal carcinoma is situated in the third rank of the urologic cancers. It is metastatic in a third of the cases, when we made the diagnosis of the cancer. Lungs, bone, the liver, the suprarenal gland and the brain stay metastatic sites of preference. Some metastatic locations are anecdotal and made the object of some publications. We report the case of a cardiac metastasis of renal carcinoma at an old patient 81 years old operated for cardiac tumor.

Do smoking and polymorphisms in xenobiotic metabolizing enzymes affect the histological stage and grade of bladder tumors?

Cigarette smoking and genetic susceptibility are the two factors most closely associated with bladder cancer development. This study sought to determine the effect of smoking and genetic polymorphisms in xenobiotic metabolizing enzymes on the histological stage and grade of bladder tumors in Tunisian patients. A total of 97 patients with urothelial cell carcinomas were examined with respect to smoking status, NAT2 (N-acetyltransferase 2), GSTM1 and GSTT1 (glutathione S-transferase Mu 1 and teta 1) genotypes distribution. Our data have reported that tobacco; NAT2, GSTM1 and GSTT1 genotypes were not associated with bladder tumor stage. When we studied the superficial bladder tumor group, we have shown that in smokers tobacco was associated with the development of low-grade tumors. Conversely, non-smoker patients carrying altered NAT2 genotypes were with a 3.67-fold increased risk of developing superficial high-grade tumors (P = 0.02; RR = 3.67; 95% CI: [1.40-9.62]).

[Retroperitoneal laparoscopy for the management of lumbar ureter stones]. / L'approche lomboscopique dans le traitement des calculs urétéraux lombaires.

INTRODUCTION: Retroperitoneal laparoscopy is a recent alternative to conventional surgical treatment of ureterolithiasis. The objective of this study was to evaluate the place of retroperitoneal laparoscopic ureterolithotomy. MATERIAL AND METHODS: The authors report 50 cases of retroperitoneal laparoscopy for lumbar ureter stones performed in 49 patients between January 2001 and December 2006. The indications were a very large (>15 mm) obstructive stone in the lumbar ureter in 88% of cases, failure of extracorporeal shock wave lithotripsy (ESWL) in 6% of cases and refusal of ESWL in 6% of cases. RESULTS: The mean stone diameter was 17 mm (range: 10-35 mm). The stone was removed by retroperitoneal laparoscopy in 46 out of 50 cases (92%). The mean operating time was 97 min. (range: 35-170 min.). The surgical conversion rate was 8%. Ten patients (20%) developed a urinary fistula requiring secondary drainage by double J ureteric stent. The mean hospital stay was 6.8 days. No cases of ureteric stenosis or kidney destruction was observed with a mean follow-up of 32 months. CONCLUSION: Retroperitoneal laparoscopic lumbar ureterolithotomy is a safe, effective and minimally invasive technique which could constitute an alternative to open ureterolithotomy in the majority of its current indications.

[Primary bilateral adrenal T-cell lymphoma. A case report rarer than B-cell lymphoma]. / Lymphome surrénalien primitif bilatéral de phénotype T. Un cas clinique beaucoup plus rare que le lymphome B.

Primary adrenal lymphoma is a rare condition. Only 70 cases were described in the literature. Adrenal lymphoma is often bilateral and in most of the cases of B-cell type. T-cell lymphoma is exceptional. The prognosis is bad and patient can die early because of acute adrenal insufficiency. We report a case of a 70-year-old man who was admitted for acute adrenal insufficiency due to primary bilateral adrenal T-cell lymphoma. He had corticotherapy and surgical exploration for intra-abdominal sepsis. He died because of multivisceral deficiency. Clinical features and imaging are not specific. (18)F-FDG PET Scan is an excellent mean to detect malignant tumor of adrenal gland. Percutaneous needle biopsy is useful to determine histology. The standard treatment is chemotherapy.

[Management of emphysematous pyelonephritis based on a series of 21 cases]. / La prise en charge des pyélonéphrites emphysémateuses. A propos de 21 cas.

OBJECTIVE: To define the clinical, laboratory and morphological features of emphysematous pyelonephritis, as well as the treatment modalities, with particular emphasis on the need for urgent treatment. MATERIAL AND METHODS: Between 1987 and 2004, 21 patients were treated for emphysematous pyelonephritis. Epidemiological, clinical, laboratory and radiological data, treatments and clinical outcome were retrospectively collected for all patients. RESULTS: This series comprised 15 women and six men with a mean age of 54.6 years. All were diabetic. Upper urinary tract obstruction was demonstrated in 47.6% of cases. The left kidney was affected in 14 patients and the right kidney was affected in six patients. Only one patient had bilateral pyelonephritis. The diagnosis was established by CT in every case. All patients received appropriate intensive care. Treatment was purely medical in one case. Emergency nephrectomy was performed in 12 patients, emergency surgical drainage was performed in three patients, percutaneous drainage was performed in two cases and ureteric catheter drainage was performed in three patients. The mortality rate in this series was 23.8%. CONCLUSION: Emphysematous pyelonephritis is a serious infection. Early diagnosis is essential, particularly in diabetic patients. The positive diagnosis is based on computed tomography and treatment is now increasingly conservative.

False penile fracture: report of 16 cases.

We determined the value of diagnostic and therapeutic approaches of false penile fractures and the outcome of treatment. We retrospectively reviewed 16 cases of presumed penile fracture with a negative surgical exploration. Clinical presentation, technique of treatment and outcome were noted. The mean age was 39 years (17-64). Nine patients were injured during sexual intercourse. All the patients presented with the presumptive diagnosis of penile fracture. False penile fracture was evoked in one patient presenting a new erection. Surgical penile exploration was carried out for all the patients without any radiological explorations. It revealed nonspecific dartos bleeding in 10 cases and avulsed superficial dorsal vein in six cases requiring venous ends ligation. All the patients regained penile appearance and potency. We can hardly distinguish false penile fracture from 'true' penile fracture with certainty either clinically or radiologically, thus, surgical exploration is mostly necessary. The prognosis is excellent.

Cystic nephroma in the adult: pathological aspects and therapeutic implications.

Cystic nephroma is a benign renal neoplasm. Since its initial description, there has been much debate regarding its origin. Preoperative diagnosis of Cystic nephroma is difficult to achieve. The differential diagnoses of Cystic nephroma are recently described mixed epithelial and stromal tumours of the kidney and cystic renal cell carcinoma. The Authors report three cases of Cystic nephroma and illustrate the clinical, radiological and histological features of this renal neoplasm.