[Entero-urinary fistula]. / Les fistules uro-digestives.

AIM: To present the results of the diagnostic and the management of entero-urinary fistulae. METHODS: we performed a retrospective study on 18 patients with entero-urinary fistulas that had been diagnosed and treated at the Hospital Ibn Sina Rabat during the period spanning 1989-2006 RESULTS: The surgery was the main etiology of fistulas. The location was colo-vesical in 2 cases, prostato-rectal in 7 cases, vesico-rectal in 2 cases, uretero-colic in 3 cases, uretro-rectal in 3 cases and uretero-ileal in 1 case. The clinical manifestations were principally urological in the form of recurrent urinary infection, pneumaturia and fecaluria. The most useful diagnostic techniques were voiding retrograde cystourethrography and abdominal CT scan showing the fistulae in 12 cases. Treatment was by surgery in 15 cases. The transperitoneal way was adopted for the upper tract fistulas and the way of York Mason preferred for the lower urinary tract fistulas. No complications have been reported in the follow-up of these patients. CONCLUSION: Although the diagnosis of entero-urinary fistulae seems easy, the management remains difficult. It depends on its location and on the general state of the patient. He must be appropriate to avoid a recurrence which the management would be more complicated.

[Ureterocele in adults based on a series of 14 cases]. / Urétérocèle de l'adulte. A propos de 14 cas.

OBJECTIVE: To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults and to determine the incidence of its main complication, vesico-ureteric reflux. MATERIAL AND METHOD: Retrospective study of 14 cases of ureterocele in adults observed between March 1989 and August 2004, corresponding to 7 males and 7 females with a mean age of 39 years (range: 17-73 years). The ureterocele was observed in a context of single ureter in 13 cases (94%) and duplicated ureter arising from the superior renal unit in one patient (7%). The ureterocele was complicated by stones in 9 cases (64%). Endoscopic meatotomy was performed in 13 patients, while immediate resection of the ureterocele followed by Hendren ureterovesical reimplantation was performed in one patient with major proximal repercussions. RESULTS: The postoperative course was uneventful in all patients including the patient treated by conventional surgery. Postoperative follow-up consisted of clinical and radiological assessment at 3 months and 6 months. Endoscopic treatment was effective in every case with resolution of low back pain and absence of residual stones when the ureterocele was initially complicated by stones. In contrast, de novo vesicoureteric reflux appeared secondarily in 5 patients (38.5%) but persisted at 6 months in only one patient, who required re-operation: resection of the ureterocele and Hendren ureteric reimplantation. CONCLUSION: Endoscopic meatotomy can be considered to be the firstline treatment for ureterocele in adults in the absence of severe dilatation of the proximal urinary tract. Its main complication remains vesico-ureteric reflux. Radiological surveillance by urethrocystography therefore appears to be essential.

[Primary renal non Hodgkin's lymphoma]. / Localisation rénale primitive d'un lymphome malin non hodgkinien (LMNH).

Primary renal non Hodgkin's lymphoma is a rare disease. The authors report a case of primary follicular lymphoma of the kidney diagnosed on nephrectomy specimen in a 53 year old man. In the light of this case and a review of the literature, aetiopathogenic, diagnostic and therapeutic aspects are discusses.

The use of isolated sigmoid colon segment for vaginal replacement in young adults.

PURPOSE: Vaginoplasty for congenital atresia, a component of the Mayer-Rokitansky-Kuster syndrome, or for gender confirmation, may be achieved by several techniques. This report focuses on the efficacy of rectosigmoid neocolporrhaphy (RSNC) for primary vaginal replacement. MATERIALS AND METHODS: From 1990 to 2002 we evaluated six patients 16-33 years old (average age 23) who required vaginal replacement. The diagnoses included the Mayer-Rokitansky syndrome in two cases, classic bladder exstrophy in 1 and male pseudohermaphrodites in three cases. The vagina was reconstructed using a 15-cm isolated sigmoid segment placed between the bladder and rectum and anastomosed to the introitus in four patients. The Frank procedure was used in two patients. RESULTS: A minimum of 1 year of followup is available in five of the six patients (mean of 32 month). Patients treated with sigmoid vaginoplasty had functional neovagina. with excellent cosmetic results and without excessive mucous production or the need for routine dilation. Stenosis at the mucocutaneous junction in one patient with a sigmoid vagina was treated with Y-V plasty. In the two patients managed by nonoperative perineal self-dilatation, there was little success noted and the two patients became surgical candidates. CONCLUSIONS: Experience with this group of patients leads us to believe that isolated sigmoid segments provides a cosmetic, self-lubricating neovagina with low rates of failure and revision, and without the need for routine dilation.

[Seminal vesicle cyst with agenesis of homolateral kidney]. / Kyste de la vésicule séminale avec agénésie du rein homolatéral.

A case of seminal vesicle with ipsilateral renal agenesis is presented. In the light of this case, symptomatology, diagnosis and treatment option are discussed.